Pandemic influenza: risk perception and protective behaviours in people with schizophrenia

Abstract

Pandemic influenza remains a major public health threat facing the 21st century, heightened by the possible future emergence of a mutant strain of the highly pathogenic avian influenza virus (H5N1). As emphasized by the Australian Health Management Plan for Pandemic Influenza, two core components of an effective response plan are: (1) communication of the best available health information to the public during the pandemic, and (2) minimization of the transmission of the influenza virus. Despite the increased vulnerability of people with schizophrenia in the event of a pandemic influenza, there is a dearth of research examining: (1) how they obtain information on health matters, (2) how they perceive the risks associated with pandemic influenza, and (3) what they are prepared to do about those risks. The research project, consisting of a cross-sectional survey and a follow-up qualitative study with in-depth interviews, was designed to examine these! issues with the aim of mitigating the negative health impact of pandemic influenza on people with schizophrenia.

In the cross-sectional survey, a purposive sample of 309 participants was obtained from health care settings in the Australian Capital Territory. This comprised 71 adults diagnosed with schizophrenia, recruited from public mental health care settings, and 238 adults without schizophrenia, a comparator group, recruited from thirteen urban general practice settings. All participants completed a questionnaire examining their use of health information sources, and their perceived risk of, and willingness to adopt protective measures against, the concurrent H1N109 influenza ('swine flu') pandemic. The qualitative study comprised eleven in-depth interviews with people with schizophrenia.

The most commonly used health information sources for people with schizophrenia were doctor (59.2%), family and friends (53.5%), and television (52.1%). However, compared with adults attending a general practice, they were found to be less likely to obtain health information from their doctor (AOR = 0.27) and the Internet (AOR = 0.43), and less likely to trust their doctor (AOR = 0.22) as a source of information on health matters. In the schizophrenia group, 54.9% perceived at least a moderate risk to themselves associated with H1N109; 37.1% perceived a substantive likelihood of contracting H1N109 if no precautionary actions were taken; and 63.2% believed it would be serious if they did contract the virus. Between-group regression analysis revealed no significant differences between participants with schizophrenia and the general public in risk perception. The majority of participants with schizophrenia reported that they were willing to be vaccinated (74.3%), isolate thems! elves (73.2%), wear a face mask (54.9%), and increase hand washing (88.6%). However, they were less likely to be willing to be vaccinated (AOR = 0.41) and to isolate themselves (AOR = 0.41) compared with the general public. Important perceived barriers were identified for each protective measure, including transport and cost for vaccination. Results of the thematic analysis of the in-depth interviews were largely congruent with the survey findings (including a strong endorsement of hand washing), but also revealed a possible complacency with respect to a future, potentially more serious, influenza pandemic, such as 'bird flu'.