Van et al. BMC Public Health 2010, 10:130 http://www.biomedcentral.com/1471-2458/10/130 Hence, understanding of and outbreak management in such institutions are essential to minimise the impact of pandemic influenza in both the institution and its surrounds. University settings are unique given the permeability of their boundaries and the groups, and the activities within the institution that affect social contact between its members. Both of which have the potential to affect behaviours and perceptions. This survey was conducted to examine the understanding of and attitudes towards pandemic (H1N1) 2009 amongst students and staff at the University of New South Wales (UNSW), Sydney, Australia and their behavioural intentions during this pandemic. Methods Context The CDC recommends that institutions of higher educa- tion balance the goals to minimize morbidity and mor- tality from pandemic influenza with the goal of minimising educational and social disruption [5]. Between April 30th and September 30th 2009, ten broad- cast emails were sent out by the Director of the Univer- sity Health Service to staff and students. Contained in the emails was information on the: (1) H1N1 situation; (2) modes of spread and common symptoms; (3) recom- mended health advice consistent with both the WHO and national recommendations; and (4) contact informa- tion for the relevant health departments [6]. Posters developed by the Commonwealth Department of Health and Ageing and UNSW were placed in high traffic areas and focused on: (1) encouraging faculty, staff and stu- dents to stay at home if symptomatic (i.e. with a fever, cough, and runny nose) and to protect each other; (2) cough/sneeze etiquette (i.e. “cover your mouth and nose when you cough and sneeze” and “dispose of used tis- sues in the bin) and (3) hand hygiene (i.e. “Wash your hands properly and regularly”). Survey Data was collected from the 29 June - 30 September, coinciding with the peak of the pandemic in Australia. An anonymous online survey was designed to assess the knowledge, attitudes and perceptions of pandemic (H1N1) 2009, which was referred to by its vernacular alternative, “swine flu”. The survey was piloted on June 11th with three students and three staff, representative of the members of the study population, and modified accordingly. The final version assessed: (1) demographic characteristics; (2) awareness, perceived personal risk and anxiety; (3) recent influenza-related behaviours changes; (4) intended behaviour in the event of various scenarios at UNSW and (5) compliance with different community interventions. In regards to the behaviour Page 2 of 9 changes, we included four changes (cancelling social plans, avoiding busy public places, cancelling/postponing travel plans and not using public transport) that were related to avoidance behaviour and not recommended by the government and five changes (buying hygiene products, receiving the seasonal influenza vaccine, using online resources for teaching and learning and stockpil- ing necessities) that were related to recommended beha- viours. The recommended behaviours questions were adapted with permission from a study undertaken by Rubin et al [7]. Participants The sample comprised of both academic and non-aca- demic staff (i.e. administration, IT and other support staff) and students at UNSW in Sydney, Australia. Par- ticipants accessed the final questionnaire via a link on an online newsletter available to all UNSW staff and students, and via an online information gateway. Emails were also sent to the heads of each Faculty, informing them of the survey. Consent was implied upon completion and submission of the questionnaire. Submitted surveys were collated in a directory and de- identified prior to analysis. Participants were offered the chance to win a $500 cash prize upon completing the survey. Ethics approval was granted by the Univer- sity of New South Wales Human Research Ethics Committee. Analysis The quantitative data on the completed survey was col- lected in Microsoft Excel. OpenEpi (version 2.3) was used to calculate [8], proportions, 95% confidence inter- vals and c2 tests for significance. Alpha was set at the 5% level. We used logistic regression to compute odds ratios to evaluate the association of demographic vari- ables and attitudes and beliefs. Results Participants A total of 2882 UNSW staff and students aged ≥18 years completed the online survey between the 29 June and 30 September 2009. The overall response rate was 5.7% (2882/50847) and most respondents were young (18-34 years, 73.9%, 2129/2882) and born in Australia (51.8%, 1492/2882) (Table 1). Academic and general staff members were both overrepresented in our sample (12.5%, 360/2882, X2 = 311.3, p < 0.001; 22.4%, 646/ 2882, X2 = 1313, p < 0.001 respectively) compared to the actual proportions employed at UNSW (4.9%, 2497/ 50847 and 5.5%, 2779/50847 respectively). Students were underrepresented (65.1%, 1876/2882, X2 = 1279, p < 0.001) compared to the proportion of internal stu- dents at UNSW (88.2%, 44833/50847).