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Perceived risk, anxiety, and behavioural responses of the general public during the early phase of the Influenza A (H1N1) pandemic in the Netherlands: results of three consecutive online surveys

Marloes Bults1*, Desirée JMA Beaujean2, Onno de Zwart1, Gerjo Kok3, Pepijn van Empelen4, Jim E van Steenbergen2, Jan Hendrik Richardus14 and Hélène ACM Voeten1

Author affiliations

1 Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, 3000 LP Rotterdam, The Netherlands

2 National Institute of Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720 BA Bilthoven, The Netherlands

3 Maastricht University, Department of Work & Social Psychology, P.O. Box 616, 6200 MD Maastricht, The Netherlands

4 Erasmus MC, University Medical Center Rotterdam, Department of Public Health, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands

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Citation and License

BMC Public Health 2011, 11:2  doi:10.1186/1471-2458-11-2

Published: 3 January 2011



Research into risk perception and behavioural responses in case of emerging infectious diseases is still relatively new. The aim of this study was to examine perceptions and behaviours of the general public during the early phase of the Influenza A (H1N1) pandemic in the Netherlands.


Two cross-sectional and one follow-up online survey (survey 1, 30 April-4 May; survey 2, 15-19 June; survey 3, 11-20 August 2009). Adults aged 18 years and above participating in a representative Internet panel were invited (survey 1, n = 456; survey 2, n = 478; follow-up survey 3, n = 934). Main outcome measures were 1) time trends in risk perception, feelings of anxiety, and behavioural responses (survey 1-3) and 2) factors associated with taking preventive measures and strong intention to comply with government-advised preventive measures in the future (survey 3).


Between May and August 2009, the level of knowledge regarding Influenza A (H1N1) increased, while perceived severity of the new flu, perceived self-efficacy, and intention to comply with preventive measures decreased. The perceived reliability of information from the government decreased from May to August (62% versus 45%). Feelings of anxiety decreased from May to June, and remained stable afterwards. From June to August 2009, perceived vulnerability increased and more respondents took preventive measures (14% versus 38%). Taking preventive measures was associated with no children in the household, high anxiety, high self-efficacy, more agreement with statements on avoidance, and paying much attention to media information regarding Influenza A (H1N1). Having a strong intention to comply with government-advised preventive measures in the future was associated with higher age, high perceived severity, high anxiety, high perceived efficacy of measures, high self-efficacy, and finding governmental information to be reliable.


Decreasing trends over time in perceived severity and anxiety are consistent with the reality: the clinical picture of influenza turned out to be mild in course of time. Although (inter)national health authorities initially overestimated the case fatality rate, the public stayed calm and remained to have a relatively high intention to comply with preventive measures.