Knowledge about pandemic influenza and compliance with containment measures among Australians

588 Bull World Health Organ 2009;87:588–594 | doi:10.2471/BLT.08.060772 Knowledge about pandemic influenza and compliance with containment measures among Australians Keith Eastwood,a David Durrheim,b J Lynn Francis,a Edouard Tursan d’Espaignet,a Sarah Duncan,a Fakhrul Islam a & Rick Speare c Objective To examine the level of stated compliance with public health pandemic influenza control measures and explore factors influencing cooperation for pandemic influenza control in Australia. Methods A computer-assisted telephone interview survey was conducted by professional interviewers to collect information on the Australian public’s knowledge of pandemic influenza and willingness to comply with public health control measures. The sample was randomly selected using an electronic database and printed telephone directories to ensure sample representativeness from all Australian states and territories. After we described pandemic influenza to the respondents to ensure they understood the significance of the issue, the questions on compliance were repeated and changes in responses were analysed with McNemar’s test for paired data. Findings Only 23% of the 1166 respondents demonstrated a clear understanding of the term “pandemic influenza”. Of those interviewed, 94.1% reported being willing to comply with home quarantine; 94.2%, to avoid public events; and 90.7%, to postpone social gatherings. After we explained the meaning of “pandemic” to interviewees, stated compliance increased significantly (to 97.5%, 98.3% and 97.2% respectively). Those who reported being unfamiliar with the term “pandemic influenza,” male respondents and employed people not able to work from home were less willing to comply. Conclusion In Australia, should the threat arise, compliance with containment measures against pandemic influenza is likely to be high, yet it could be further enhanced through a public education programme conveying just a few key messages. A basic understanding of pandemic influenza is associated with stated willingness to comply with containment measures. Investing now in promoting measures to prepare for a pandemic or other health emergency will have considerable value. Une traduction en français de ce résumé figure à la fin de l’article. Al final del artículo se facilita una traducción al español. .ةلاقلما هذهل لماكلا صنلا ةياهن في ةصلاخلا هذهل ةيبرعلا ةمجترلا a Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. b Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia. c Anton Breinl Centre for Public Health and Tropical Medicine, James Cook University, Townsville, Qld, Australia. Correspondence to Keith Eastwood (e-mail: keith.eastwood@hnehealth.nsw.gov.au). (Submitted: 29 October 2008 – Revised version received: 16 February 2009 – Accepted: 26 February 2009 – Published online: 14 July 2009 ) Introduction To limit the spread of disease during the early containment phase of an influenza pandemic response, WHO recommends the use of non-pharmaceutical interventions (NPIs), includ- ing public education, social distancing, home quarantine and travel restrictions.1 These control measures are reflected in the Australian Health Management Plan for Pandemic Influenza.2 However, compliance with this approach is dependent on community understanding of the required control measures and their value in disease mitigation.3 Historical records show that if NPIs are promptly implemented during pandemics, disease transmission can be reduced,4–7 an observation sup- ported by mathematical modelling.8 This study examines the Australian public’s understand- ing of pandemic influenza, its expressed willingness to comply with public health containment measures, and factors influ- encing compliance. Methods Study participants and study protocol A cross-sectional computer-assisted telephone interview sur- vey of a representative sample of Australians aged 18 years and over was conducted in June 2007. The latest Australian tele- phone database available electronically, the 2002 Electronic White Pages, was used to provide sample proportions for all states and territories. By using a random number generator, a corresponding sample of names, addresses and telephone numbers was drawn from the 2007 printed telephone directo- ries according to telephone exchange regions. An introductory letter was dispatched to all households a week before telephone contact was made. Experienced telephone interviewers made calls between 09:00 and 20:00 local time, with up to seven contact attempts made for each randomly-selected telephone number. The adult household member whose birthday was closest to the interview date was invited to participate. Those eligible were people 18 years or older who provided verbal consent and could converse in English. Sample size was calculated for an a of 0.05 and a power (1 − b) of 0.80 using prevalence information from a comparable study in the United States of America (USA).9 We estimated that approximately 1200 respondents would be required to provide statistically sound estimates at the national level. Interview questions covered five principal areas: demo- graphics and household circumstances, knowledge about pandemic influenza, expressed willingness to comply with 589Bull World Health Organ 2009;87:588–594 | doi:10.2471/BLT.08.060772 Special theme – Public health communication Understanding of pandemic influenza in AustraliaKeith Eastwood et al. containment measures, barriers to com- pliance with containment measures, and the preferred method for receiving health communication. In this report, the exact questionnaire wording is re- corded in italics. From a total of 2201 telephone contacts, there emerged 1166 success- ful interviews; 846 refusals (279 gave no reason, 248 stated no interest, 115 householders did not pass the call through to the eligible person, 58 indi- cated being too busy, 53 felt too ill, 93 gave miscellaneous reasons) and 189 cases of ineligibility (reasons recorded for 159: 111 were non-English speak- ing, 24 were at business numbers, 15 had an illness that limited comprehen- sion and 9 had hearing difficulties). This resulted in a participation rate of 58.0%. Interview procedure Participants were asked if they under- stood the term “pandemic influenza”. Those that answered in the affirmative were then asked four questions, each with two possible reply options. Follow- ing this, to ensure that all respondents were able to answer the remaining ques- tions regardless of their knowledge of influenza, everyone was informed that “pandemic influenza is a disease that is spread between people”. The compliance questions were asked early in the inter- view and repeated towards the end after the following information was provided: “We are talking about an entirely new type of influenza virus that spreads easily from person to person. No one would have natural immunity to it and every age group could be affected. Potentially a quarter to a third of the population could get sick. In the 1918 Spanish flu pandemic at least 40 million people died and a third of the world’s population was infected. In this case, the usual flu vac- cine would not have prevented illness”. Statistical methods The change in reported willingness to comply with public health measures before and after providing informing on pandemic influenza was assessed using McNemar’s test for paired data. Through univariate logistic regression models, we identified factors potentially related to non-compliance with pro- posed measures, and multivariable lo- gistic regression models were developed using a backward stepwise procedure. Base SAS and SAS/STAT components of SAS 9.13 statistical software (SAS In- stitute Inc., Cary, NC, USA) were used for all analyses. The sample population was weighted to the age-sex distribution of the Australian adult population in all models.10 Results are presented as odds ratios (ORs) and their 95% confidence intervals (CIs). Ethics Ethics approval was obtained from the Hunter New England Human Research Ethics Committee (approval number 07/04/18/5.06). Results The estimated resident Australian popu- lation for 2006 was used to assess the representativeness of the study sample.10 There were more females (61.6%) than males and older age groups were moderately over-represented, but geo- graphically the sample closely reflected the Australian population distribution. In 140 (12.0%) cases a language other than English was spoken at home and sample data closely matched census data in terms of education.11 Unless otherwise stated, the denominator used for the analysis was the complete sample of 1166 individuals. Knowledge of pandemic influenza When asked whether they were “familiar with the term pandemic flu or pandemic influenza”, 44.3% of participants replied that they were, 31.1% were unsure and 24.5% reported not having heard the term. Those who claimed familiarity were then asked: 1. if the disease “(a) was usually mild and rarely caused death; or (b) could be serious with some deaths expect- ed” – 97.3% answered correctly (b); 2. if the disease “(a) could spread with- in a single country; or (b) spread through all countries” – 86.5% an- swered correctly (b); 3. if “(a) all ages could be affected; or if (b) the young and elderly were most likely to be affected” – 66.7% an- swered correctly (a); 4. if the disease “(a) is easily spread by coughing and shaking hands; or (b) not” – 86.1% answered correctly (a). Among this group, 50.9% of respon- dents provided correct answers to all four questions. Of the 517 who claimed to know about pandemic influenza, 33.1% thought there had been cases in the last 5 years, 60.9% correctly re- ported no cases and 6.0% were unsure. Risk perception After being informed that “pandemic influenza is a disease that is spread between people”, respondents were asked if they considered it likely that pandemic influenza would occur in Australia in the next 5 years. Overall, 15.2% thought it likely, 44.4% thought it somewhat likely, 24.3% considered it not very likely, 7.0% thought it not at all likely, and 9.1% reported not know- ing. Of the 476 respondents in paid employment but not self-employed, 14.1% indicated that their employer had made business continuity plans for a pandemic or similar emergency. Willingness to comply All respondents were asked if they were willing to comply with specific public health containment measures. Re- sponses were graded as either compli- ance or non-compliance (“don’t know” responses were included in the latter group). This question was repeated towards the end of the interview after a brief description of pandemic influenza had been provided (Table 1). Home quarantine Willingness to comply with home quarantine was analysed according to demographic data (Table 2). We found that gender, being employed but un- able to work from home and having a basic knowledge of pandemic influenza (respondents who provided correct an- swers to all four questions) were statisti- cally associated with stated willingness to comply. When these parameters were included in a multivariate model, they remained statistically significant (Table 2). Overall, 75.5% of respondents an- swered having someone who could care for them if they were in home quaran- tine. For fever monitoring, 56.6% of re- spondents reported owning a functional thermometer. In 52.5% of households there was an occupant requiring daily medication and 51.8% reported having food storage for 7 days or less. Financial independence Of the 611 employed respondents (52.4% of the total sample), 36.7% reported no current leave entitlements 590 Bull World Health Organ 2009;87:588–594 | doi:10.2471/BLT.08.060772 Special theme – Public health communication Understanding of pandemic influenza in Australia Keith Eastwood et al. Table 1. Stated intention to comply with control measures before and after briefly describing pandemic influenza to a sample of Australian adults surveyed by telephone, 2007 Question Before After Percentage point change (95% CI) Yes No Yes No % % % % 1. If told you might have had contact with pandemic influenza, would you stay home 7–10 days to avoid exposing others? 94.1 5.9 97.5 2.5 3.4 (2.2–4.6) 2. If told you needed to avoid public events, would you? 94.2 5.8 98.3 1.7 4.1 (2.9–5.4) 3. If told you needed to postpone social gatherings, would you? 90.7 9.3 97.2 2.8 6.5 (4.9–8.0) CI, confidence interval. and 27.2% had up to 4 weeks. If the emergency went beyond 2 weeks, 30.4% reported they would experience financial difficulties. Social distancing Of respondents from the 394 house- holds with children, 96.7% claimed they would keep the children away from others for one month if schools and child-care facilities were closed. If their “town or neighbourhood were placed in quarantine”, 84.8% reported that they would “very likely” stay within the quarantine area, 10.4% said they would be “somewhat likely” to stay, 2.0% were “not too likely” and 2.8% were “not at all likely” to stay. Of the 581 respon- dents who had used air transport in the past 12 months, 97.2% reported being willing to avoid air travel for a month if requested. Additional measures In the event of exposure to pandemic influenza, 88.3% of respondents re- ported being willing to take antiviral medication, but when told the drugs were “not guaranteed to be effective and could cause some minor side effects like stomach discomfort” this propor- tion dropped to 70.0%. Reasons for refusal included a fear of side-effects, a preference for natural therapies and will- ingness to accept the risk that exposure may lead to disease. When asked “during a pandemic, would you wear a surgical- type mask when mixing with people in public if asked to do so?” 95.1% of participants reported being willing to comply with this control measure. When asked if they were willing to present to a special assessment clinic as requested instead of to their general practitioner if they thought they had pandemic influenza, 94.0% answered affirmatively. Communication The single “preferred method for receiv- ing detailed information on important health issues” was stated to be televi- sion (31.2%) mail (27.8%), Internet (13.9%, with 68.1% reporting home Internet access), radio (13.8%), news- papers (11.0%) and other (2.3%). The person most trusted “to provide reliable health information to the media” was the state/territory chief medical officer (44.3%), a local health spokesperson (28.4%), the Prime Minister (16.1%), the state premier/chief minister (3.1%), and 7.9% of respondents were unsure. When seeking “more information on pandemic flu”, contacting a general practitioner was the preferred option (33.2%), followed by; accessing an of- ficial web site (31.8%), telephoning a health hotline (29.2%) and contacting the public health unit (4.4%). Discussion Only 44% of this national sample of adult Australians reported any knowl- edge of the term “pandemic influenza”, a finding similar to that of a study con- ducted in the USA in 2006 in which 41% of respondents had previously heard of this term.9 Further investiga- tion revealed that only 51% of Austra- lian respondents familiar with the term were able to correctly answer all four basic knowledge questions, so that the true proportion of Australians with a reasonable understanding of pandemic influenza may be as low as 23%. Our multivariable logistic regression model showed a strong association between a demonstrated basic knowledge of pandemic influenza and willingness to comply with home quarantine. These findings lend support to the value of a campaign to improve knowledge before an actual health emergency, as the threat of a serious disease outbreak can generate fear and misapprehension and thereby complicate response efforts if the public is ill-informed.12 In an early containment response, control of pandemic influenza and other emerging communicable diseases for which no vaccines are currently available is dependent on community compliance with NPIs.4–6 The level of compliance may be influenced through the provision of accurate information delivered within a structured commu- nication programme.13 Distribution of promotional material during the inter- pandemic period will demonstrate to the public that health authorities are transparent about the risk and have containment plans in place. This has the added benefit of allowing people to accept socially unfamiliar control measures such as wearing masks and home quarantine, before a pandemic occurs. The strategy should also include the promotion of personal infection control practices, such as hand wash- ing, fever-monitoring and staying at home when sick − all lifestyle activities that would protect against any commu- nicable disease. Our findings suggest that in Aus- tralia, television, direct mail-out, the Internet and the radio are the preferred media for disseminating information about pandemic influenza. When it comes to pandemic information, people appear to trust state or local health representatives above politicians. Our finding that general practitioners were the preferred source of additional 591Bull World Health Organ 2009;87:588–594 | doi:10.2471/BLT.08.060772 Special theme – Public health communication Understanding of pandemic influenza in AustraliaKeith Eastwood et al. Table 2. Stated intention to comply with home quarantine following exposure to pandemic influenza in a sample of Australian adults surveyed by telephone, 2007 Characteristic n Compliance % Non- compliance % Univariate models predicting non-compliance OR (95% CI) Final multivariable models predicting non-compliance OR (95% CI) Gender Male 448 92.2 7.8 2.1 (1.3–3.4) 2.0 (1.3–3.1) Female 718 95.3 4.7 1.0 1.0 Age, in yearsa NI 18–39 249 93.2 6.8 2.1 (1.0–4.5) 40–64 600 93.5 6.5 1.7 (0.8–3.7) 65+ 316 95.9 4.1 1.0 Highest education levela NI University 283 93.6 6.4 1.0 (0.5–1.8) Technical college 272 94.5 5.5 0.9 (0.5–1.7) Year 11 or 12 196 92.9 7.1 1.0 (0.5–1.9) Primary to year 10 414 94.7 5.3 1.0 Location NI Urban 832 93.6 6.4 1.6 (0.9–2.8) Rural/remote 334 95.2 4.8 1.0 Children in household NI No 772 94.0 6.0 1.2 (0.8–1.9) Yes 394 94.2 5.8 1.0 Employment situationa Self-employed, unable to work from home 29 79.3 20.7 7.3 (3.0–17.5) 4.9 (2.3–10.5) Self-employed, able to work from home 105 97.1 2.9 0.6 (0.1–2.3) 0.6 (0.2–1.8) Wage earner, unable to work from home 369 89.2 10.8 3.4 (1.9–6.0) 3.3 (2.0–5.4) Wage earner, able to work from home 107 96.3 3.7 1.2 (0.4–3.2) 1.2 (0.5–2.8) Not in paid employment 555 97.1 2.9 1.0 1.0 Knowledge of pandemic flu “Unsure/never heard of term” 649 92.9 7.1 2.8 (1.4–6.1) 3.0 (1.6–5.7) “Yes,” < 4 replies to questions correct 254 94.9 5.1 1.6 (0.7–3.9) 1.8 (0.8–3.7) “Yes,” all 4 replies to questions correct 263 96.2 3.8 1.0 1.0 CI, confidence interval; NI, not included in the final model; OR, odds ratio. a One person did not answer. information highlights the importance of including them in any communica- tion plan for the containment of pan- demic influenza. An Australian study conducted in 2004 also showed that general practitioners were regarded by the public as a source of reliable in- formation during emerging infectious disease threats.14 The low percentage of respondents who considered pandemic influenza likely to occur in the next 5 years re- sembles the percentage reported in a 2007 study conducted in New South Wales, Australia.15 As health protection actions are influenced by risk percep- tion, a communication strategy will need to focus on providing a simple and convincing risk assessment16 while concurrently offering recipients ways to mitigate the risk to themselves, their family and their community. The reported level of willingness to comply with three principal contain- ment measures exceeded 90%, a finding similar to that of a 2006 study in the USA.9 However, with the delivery of minimal additional information about the seriousness of the disease, it was possible to increase this to over 97%. The willingness to wear a mask during a pandemic was surprisingly high (95%), particularly as this is not common prac- tice in Australia. Use of masks by the general public in China, Hong Kong, Special Administrative Region, during the 2003 severe acute respiratory syn- drome (SARS) outbreak was below this level. The fact that it increased from 12% on day 10 to 85% on day 6217 shows that the public is more likely to adopt NPIs as risk perception increases. This general willingness to wear masks is an excellent starting point for tar- geted reinforcement through health education messages. Modelling suggests that the higher the secondary infection rate, the more compliance will be nec- essary for NPIs to be successful.8 Study limitations We were able to survey a large, rep- resentative cross-section of the adult Australian public. However, the study design was based on telephone con- tact, so that people without a landline telephone and those living in areas not connected to a telecommunication network were excluded. While infor- mation is not available for the entire 592 Bull World Health Organ 2009;87:588–594 | doi:10.2471/BLT.08.060772 Special theme – Public health communication Understanding of pandemic influenza in Australia Keith Eastwood et al. country, in 2007 landline coverage was reported to be 89.3% in Western Australia 18 and in 2003, Queensland’s coverage was found to be 95.3%.19 The personal telephone approach to collecting data may have encouraged respondents to report greater willing- ness to comply with measures than if a passive reporting method, such as an online questionnaire, had been applied. It is also likely that when individuals are confronted with an actual pandemic situation and more specific information becomes available, their behaviour may deviate from their stated inten- tion. Researchers wishing to conduct similar studies in countries where access to landline telephones is limited may need to consider using other survey methods. Our response rate of 58% exceeds the recommended 50% minimum mark suggested by Lindner to reduce the threat of non-response error.20 Re- gardless, we acknowledge that we still lack information about a substantial proportion of the target population. With interviewers instructed to re- spect the right of people to decline to participate in surveys, obtaining data from this group will always remain a challenge. Non-responders may also be difficult to reach in a health emergency and less likely to comply with public health measures than responders, a fact that further emphasizes the value of an early and multi-pronged promotional approach. There were 111 telephone con- tacts with people who did not speak English and could not be interviewed. If this group is combined with other minorities, such as Aboriginal Austra- lians and Torres Strait Islanders, who are under-represented in telephone ownership, then important sub-popu- lations deserve further consideration. The special circumstances of people with low incomes and of racial and ethnic minorities have been previ- ously noted.21 Out of humanitarian and epidemiological considerations, specific research based on culturally appropri- ate methods should be conducted, to ensure that minorities and marginalised groups are not neglected during com- munication efforts to prepare for a future pandemic. Conclusion In the early containment phase of a pan- demic response, compliance with social distancing and adherence to stringent infection control practices will be criti- cal for limiting community transmis- sion. Our findings suggest that people with a basic knowledge level are more likely to comply with public health containment measures than those who lack such knowledge, yet studies in both Australia and the USA have shown that much of the public has a limited understanding of pandemic influenza. In addition, stated compliance with containment strategies, regardless of how high, can be further improved by providing some basic health in- formation. We encourage investment in an inter-pandemic communication strategy that honestly and accurately informs the public of the threat and of the measures that will mitigate risk to themselves and to their families and communities. Furthermore, if such a strategy were applied today, it could have immediate value in limiting the transmission of other communicable diseases, as well as long-term benefits in preparing people for a sustained effort against pandemic influenza. A strong public communication plan should be given equal status with other NPIs in the global response stratagem. This manuscript describes the first national survey to determine the state of public knowledge on pandemic influenza in Australia and explores im- portant factors that may determine the success of containment policies such as social distancing and home quarantine. A communication strategy consisting of key messages and delivered through preferred communication channels would significantly increase the Austra- lian public’s willingness to comply with recommended containment measures. Very few large national studies of this type have been reported in the litera- ture, and this may be the first to actu- ally explore the public’s understanding of pandemic influenza and statistically relate it to compliance. Obtaining in- formation on the public’s knowledge, level of cooperation and preferred com- munication channels before a pandemic may be useful for developing national communication strategies. From our findings policy-makers and researchers in other countries may come to under- stand the issues they should explore in more detail in their own settings. The information presented in this manu- script is important for the planning of successful pandemic containment strategies in Australia and may have in- ternational relevance. ■ Acknowledgements We thank Derene Anderson, David Crompton, Anne Taylor and the excel- lent interviewer team. Competing interests: None declared. Résumé Connaissances sur la grippe pandémique et observance des mesures d’endiguement par les Australiens Objectif Etudier le niveau d’observance déclaré des mesures de santé publique contre la grippe pandémique et les facteurs influant sur la coopération des Australiens à l’endiguement de cette maladie. Méthodes Une enquête par entretien téléphonique assistée par ordinateur a été menée par des enquêteurs professionnels pour recueillir des informations sur les connaissances de la population australienne au sujet de la grippe pandémique et sur sa volonté de respecter les mesures de santé publique contre cette grippe. L’échantillon a été randomisé en utilisant une base de données électronique et des annuaires téléphoniques imprimés pour garantir la représentativité de cet échantillon à l’égard de tous les Etats et tous les territoires australiens. Après avoir expliqué aux personnes interrogées ce qu’est la grippe pandémique pour s’assurer qu’elles comprennent l’importance du problème, nous avons répété les questions relatives à l’observance des mesures et nous avons analysé les variations des réponses par le test de McNemar pour données appariées. Résultats 23 % seulement des 1166 personnes interrogées ont manifesté une compréhension claire du terme « grippe pandémique ». Parmi les personnes interrogées, 94,1 % ont indiqué qu’elles étaient disposées à respecter la quarantaine à domicile, 94,2 % qu’elles éviteraient les événements publics et 90,7 % qu’elles différeraient les rassemblements sociaux. 593Bull World Health Organ 2009;87:588–594 | doi:10.2471/BLT.08.060772 Special theme – Public health communication Understanding of pandemic influenza in AustraliaKeith Eastwood et al. Après explication du terme « grippe pandémique » aux sujets de l’enquête, l’observance déclarée a augmenté significativement (pour atteindre respectivement 97,5 %, 98,3 % et 97,2 %). Les personnes ayant indiqué ne pas être familiarisées avec ce terme, les sujets de sexe masculin et les employés ne pouvant travailler à leur domicile ont manifesté une moindre disposition à respecter les mesures. Conclusion En Australie, si la menace se concrétisait, l’observance des mesures d’endiguement contre la grippe pandémique serait probablement bonne, bien qu’elle puisse encore être améliorée par un programme d’éducation du public véhiculant juste quelques messages clés. Une compréhension générale de la notion de grippe pandémique est associée à d’une volonté déclarée de respecter les mesures d’endiguement. Il y aurait un intérêt considérable à investir maintenant dans la promotion de mesures pour se préparer à une pandémie ou autre urgence de santé publique. Resumen Conocimientos sobre la gripe pandémica y cumplimiento de las medidas de contención en la población australiana Objetivo Determinar el grado de cumplimiento declarado de las medidas de salud pública contra la gripe pandémica y estudiar los factores que influyen en la cooperación necesaria para controlar esa pandemia en Australia. Métodos Entrevistadores profesionales llevaron a cabo una encuesta telefónica asistida por ordenador a fin de reunir información sobre los conocimientos del público australiano acerca de la gripe pandémica y su determinación de observar las medidas de salud pública adoptadas para controlarla. La muestra fue seleccionada aleatoriamente a partir de una base de datos electrónica y de guías telefónicas impresas para procurar que fuese representativa de todos los estados y territorios australianos. Tras explicar a los encuestados en qué consiste la gripe pandémica para que entendieran la importancia del tema, se repitieron las preguntas sobre el cumplimiento. La variación sufrida por las respuestas fue analizada mediante la prueba de McNemar para datos apareados. Resultados Sólo un 23% de los 1166 encuestados demostraron comprender cabalmente lo que supone una «gripe pandémica». Entre los entrevistados, un 94,1% manifestó estar dispuesto a cumplir una cuarentena domiciliaria; el 94,2%, a evitar actos públicos; y el 90,7%, a aplazar encuentros sociales. Después de haber explicado a los entrevistados el significado del término «pandemia », el cumplimiento declarado aumentó significativamente (al 97,5%, 98,3% y 97,2% respectivamente). Los que manifestaron no conocer bien el significado de la expresión «gripe pandémica,» los encuestados varones y los empleados que no podían trabajar desde su domicilio se mostraron más reacios a seguir las recomendaciones. Conclusión En Australia, si se materializase la amenaza, el cumplimiento de las medidas de contención contra la gripe pandémica sería probablemente alto, no obstante lo cual podría mejorarse mediante un programa de educación del público que transmitiera simplemente unos cuantos mensajes clave. Unos conocimientos básicos sobre la gripe pandémica se asocian a la voluntad declarada de cumplir las medidas de contención. Invertir ahora en promover medidas de preparación para una pandemia u otra emergencia sanitaria constituye una opción beneficiosa. صخلم اهئاوتحا تاءارجلإ مهلاثتماو ةيحئاجلا ازنولفنلإا لوح ينيلاترسلأا ىدل فراعلما ةصاخلا ةيمومعلا ةحصلا تاءارجإب نلعلما لاثتملاا ىوتسم ةسارد :فدهلا نم نواعتلا لىع رثؤت يتلا لماوعلا لىع فُّرعتلاو ةيحئاجلا ازنولفنلإا ةحفاكبم .ايلاترسأ في ةيحئاجلا ازنولفنلإا ةحفاكم لجأ نوينهم اهب ماق بوساحلا ةدعاسبم ةينوفيلت ةلباقلم حسم يرُجأ :ةقيرطلا نع ينيلاترسلأا ىدل فراعلما لوح تامولعلما عمجل تلاباقلما في نوصصختم ةيمومعلا ةحصلا تاءارجلإ لاثتملال مهدادعتسا لوحو ةيحئاجلا ازنولفنلإا تايطعم ةدعاق مادختساب ًايئاوشع ةنيعلا رايتخا مت دقو .ةحفاكلماب ةصاخلا عيمجل ةلثمم ةنيعلا نوك نماضل فتاوهلا ماقرلأ ةعوبطم لئلادو ةينوتركيلإ ةيهام ينبيجتسملل نوثحابلا فصو نأ دعبو .ةيلاترسلاا ضيارلأاو تايلاولا دق لاثتملاا لكاشم نإف كلذ ةيمهأو اهل مهمهف نماضل ةيحئاجلا ازنولفنلإا تايطعملل رماين كام رابتخاب اهليلحت مت دق ةباجتسلاا في تايرغتلاو ترركت .ةجودزلما حلطصلم ًاحضاو ًماهف ًابيجتسم 1166 ينب نم %23 رهظأ دقل :تادوجولما مهنم %94.1 غلبأ مهتلباقم تتم نيذلا ءلاؤه نمو .»ةيحئاجلا ازنولفنلإا« بنجتل مهنم %94.2و ،ليزنلما يحصلا رجحلل لاثتملال مهدادعتسا نع حشر نأ دعبو .ةيعماتجلاا تابسانلما ليجأتل %90.7و ةيمومعلا ثادحلأا لاثتملاا نع نلاعلإا داز ،تلاباقلما في كترشا نلم ”ةحئاجلا“ ىنعم نوثحابلا رجحلل لاثتملال مهدادعتسا اودبأ نَم ىدل %97.5 لىإ لصوف ةظوحلم ةدايز ،ةيمومعلا ثادحلأا بُّنجتل هدادعتسا ىدبأ نَم ىدل %98.3و ليزنلما يحصلا ناك نم امأ .ةيعماتجلاا تابسانلما ليجأتل هدادعتسا ىدبأ نم ىدل %97.2و ازنولفنلإا حلطصم عم مهفلآت مدع نع اوغلبأ دقف كلذل لاثتملال ًادادعتسا لقأ .مهتويب نم لمعلا نوعيطتسي لا نيذلا ينلماعلاو روكذلا نم ةيحئاجلا مازتللاا نإف ايلاترسأ في ةيحئاجلا ازنولفنلإاب ديدهتلا رهظ اذإ :جاتنتسلاا نكيم نكلو ،ًاعفترم نوكي نأ بلغي ةيحئاجلا ازنولفنلإا ءاوتحا تاءارجإب .لئاسر عضب سانلل لقني يمومع يفيقثت جمانرب للاخ نم ثركأ هزيزعت لاثتملال دادعتسلاا نع نلاعلإا عم نمازتي ةيحئاجلا ازنولفنلإل سياسلأا مهفلاف زيزعتلا تاءارجإ في نهارلا تقولا في رماثتسلاا ُّدَعُيو .اهئاوتحا تاءارجلإ .ماه ةميق اذ ةيحصلا ئراوطلا نم اهيرغلو تايحئاجلل ب ُّهأتلل 594 Bull World Health Organ 2009;87:588–594 | doi:10.2471/BLT.08.060772 Special theme – Public health communication Understanding of pandemic influenza in Australia Keith Eastwood et al. 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