BMC Public Health 2009, 9:258 http://www.biomedcentral.com/1471-2458/9/258 "It's really important to stay safe as you won't be able to care for them if you get ill" (F2 female, age 24). Although participants were particularly motivated to pro- tect the health of their family and loved ones, they also expressed a wider sense of responsibility to protect the health of any 'other' in society at risk of infection. However, negative attitudes were also expressed in response to all of the recommended infection control behaviours. The recommendations were deemed difficult, hard or awkward to undertake, with a few participants suggesting their implementation would be impossible. Similarly, a large number of participants dismissed the behaviours as bothersome, inconvenient and not worth the effort: "I don't think that anybody washes their hands more than what they already do. You only wash your hands at normal intervals that I think you would normally, like if you're eating, after you've been to the toilet, etcetera" (F8 male, age 52). "I guess it's just a bit like, a bit of a hassle as well, just like thinking 'Oh, an hour's passed. I need to wash my hands"' (I3 female, age 19). A few participants expressed concern about the stigma which may be associated with frequent handwashing: "People might think you're a bit nuts if you did it out- side the home – you'd get some funny looks wouldn't you?" (F5 male, age 49). Over half of the participants questioned the effectiveness of the recommended infection control measures, believ- ing that transmission of infection, particularly pandemic outbreaks, cannot be controlled and one must just "accept fate" (F10, female, age 24). This was a view primarily expressed by younger participants: "I'd say um in terms of a pandemic it makes it sound like it's unstoppable anyway so if you're gonna get it you're gonna get it despite whatever you can do to try and help it it won't stop the pandemic and that's why it's called a pandemic" (F9 male, age 20). Nearly all of the participants stated that some or all of the measures were unnecessary, too extreme or ineffective. Indeed, a common belief was that pandemic influenza would not originate in the UK, thus allowing scientists time to develop a vaccine: "I'm not sure though 'cause if this is, if they don't even know what this flu is and they haven't found any vac- cines or anything for it how do they know that anti- bacterial on your hands is gonna work? And just like washing your hands how do they know it's gonna stop, if you touch something oh it's alright I'll wash my hands how do they know it's gonna protect you?" (F7 male, age 23). "P2: You've gotta think, I think we're a quite clean country compared to other places like I said it will be a less P4: Developed P2: Developed country I think that develops it first P1: And that spreads it quicker P4: And that will educate us P1: We can get a vaccine off of them, sounds nasty but it's true, it's how the world works" (F6 P2: male, age 24, P4: male, age 23, P1: male, age 23). Many participants believed that if somebody did contract a serious infection they would be treated in hospital, mak- ing infection control behaviours in the home redundant. Being too clean or too pedantic about hygiene was also considered detrimental to health. Indeed, a few partici- pants stated that you should actually be worried if you did not catch a cold and that the immune system is strength- ened by catching and fighting infections: "P1: Yeah but I don't think you can be too um pedan- tic about it I mean if you're too clean I mean then you're P3: Everything will jump on you P1: Yeah yeah" (F5 P1: female, age 61, P3: male, age 49). "P1: Oh yeah if you don't get a cold at least once a year there's something wrong with you" (F6 male, age 23) Colds and seasonal influenza were considered 'normal' illness which did not pose a personal or serious threat to healthy individuals; only vulnerable individuals such as the elderly or very young need be concerned. Participants stated that infection control behaviours are only necessary for more serious, infectious diseases. Selfish attitudes were prevalent in the context of non-pan- demic influenza, suggesting that it was the responsibility of others to implement the behaviours. Page 6 of 11 (page number not for citation purposes)