BMC Public Health 2009, 9:258 http://www.biomedcentral.com/1471-2458/9/258 epidemic [30], and suggests that the motivation to protect family members may not be a culture-specific phenome- non. That said, the role of social responsibility in infection control is a complex issue. For example, some participants also expressed selfish attitudes, passing responsibility for the implementation of infection control behaviours to other members of the household. Although such attitudes were more often expressed in the context of non-pan- demic influenza, survey studies conducted during the SARS epidemic [13] suggest that selfish attitudes may also be influential in pandemic contexts. More research is required to understand the balance between the motiva- tion to protect oneself, family and others and how these motivations will interact to influence behaviour in pan- demic contexts. Several factors were cited as likely to influence the ability to implement infection control behaviours. Practical diffi- culties such as access to facilities and skin irritation were similar to those cited by health care workers [22,23]. Par- ticipants stated they would be unable to undertake social distancing measures in the event of a pandemic due to the need to care for and remain close to other household members. This supports the findings of previous qualita- tive research conducted during the SARS epidemic [28]. Despite demonstrating adequate knowledge regarding infection transmission, several participants stated they would benefit from more comprehensive education and/ or reminders regarding infection control behaviours. Several of the themes identified within this study fit within the conceptual model proposed by Curtis, Dan- quah, and Aunger [31] to explain the handwashing prac- tices of caregivers in developing countries. The implementation of infection control behaviours appears to depend on a number of environmental (e.g. time, energy, availability of facilities, social norms), motiva- tional (e.g. social responsibility, social relationships, self- ishness) and habitual (e.g. education, use of memory aids) factors. Any conclusions drawn from this study must be consid- ered tentative only due to a number of considerations. Although a fairly large and varied sample of participants was recruited, the sample size does not permit conclu- sions regarding the effect of sociodemographic factors such as age, gender, occupational background, relation- ship status or whether or not one has children. The effect of social influences on responses seemed evident in a minority of the discussions. For example, participants showed a tendency toward conforming to the responses of their friends, partner or spouse. It is also possible that dif- ferent responses may have been expressed in individual interviews. There were some indications of 'groupthink' [45], particularly evident within male dominated discus- sions, where a strong consensus was reached within the group without consideration of alternative attitudes and opinions. This precludes conclusions based on gender as it is unknown whether these males would express the same attitudes to infection control behaviours outside of this group situation. Most importantly, given the hypo- thetical nature of the present study, it is quite possible that in the event of a pandemic individuals may behave entirely differently than anticipated, for better or for worse. Further research is needed in order to confirm and/or develop the conclusions drawn. For example, it would be useful to verify and quantify the extent to which reserva- tions about the acceptability and practicality of social dis- tancing may pose a motivational barrier to this preventive behaviour. Attention should also be paid to identifying the role of sociodemographic factors and how they may differentially affect willingness to implement infection control behaviours. Future research should also seek to validate the extent to which the factors mentioned by par- ticipants really influence behaviour, and to empirically test whether attitudes and behaviour can be changed by intervention. Conclusion Despite the limitations outlined, our findings may be of value when designing infection control interventions. Of the behaviours likely to influence infection transmission, handwashing was regarded by our participants as more feasible than cough and sneeze hygiene and more accept- able than social distancing, and so may be a useful target for health promotion. Consequently, encouraging hand- washing will form the key focus of our web-based inter- vention, since attempting to promote behaviours that people are unable or unwilling to engage is naturally more likely to provoke scepticism and low 'self-efficacy' – a self- fulfilling anticipation of failure [46]. Interventions may also need to address a number of beliefs identified in this study as potential barriers to carrying out infection control behaviours. For example, it may be necessary to persuade members of the community that pandemic influenza could pose a real threat to those living in developed west- ern countries, that infection control measures can be effec- tive, and that it is important to protect oneself from infection in order to be able to care for family members. In addition to these motivational arguments, practical measures may be needed to support implementation, such as education, reminders and provision of hand gel. Competing interests The authors declare that they have no competing interests. Page 9 of 11 (page number not for citation purposes)