BMC Public Health 2009, 9:258 http://www.biomedcentral.com/1471-2458/9/258 "No 'cause I'd be expecting people looking after me to wash their hands 'cause I've already got it so what do I wanna keep washing me hands for (laughs)" (F8 female, age 44). In the context of a close or intimate relationship there was a lack of concern about being near to an infected loved one, and a fear of offending or insulting the infected per- son who would be in need of comfort when ill: These selfish attitudes took two forms; either it is the responsibility of the ill person to protect others from infection, or it is the responsibility of the healthy person to protect themselves from becoming ill. In some instances these two contradictory attitudes were expressed by the same participant! A few participants stated that they did not feel motivated to undertake the recom- mended behaviours because they were concerned that other people would not be implementing them: "But then I would think if I was to do this, the next, the next person isn't, why should I blow out the stops" (F6 male, age 24). Participants frequently attempted to compensate for their negative attitudes by suggesting 'easier' behaviours such as the use of antibacterial gel, gloves or face masks. Alterna- tively, some participants said that they would devote more effort to the performance of one behaviour, particu- larly cleaning or handwashing, in order to compensate for the non-performance of other behaviours such as social distancing or not using tissues. Factors relating to the implementation of infection control measures Participants suggested that behaviours already performed were more likely to be implemented. Commonly per- formed behaviours included: washing hands six times per day, particularly prior to eating; washing more regularly when ill; increasing one's distance from ill persons; and increasing one's distance when ill. A few participants con- sidered cough hygiene measures "proper behaviour" (F4 female, age 26) which should be undertaken regardless of whether one is ill or not. Social isolation of infected persons was not seen as an acceptable measure, especially if the infected person was a child. The need or desire to care for ill persons was seen as a major barrier to the implementation of social distancing measures. Indeed, some considered that it would be self- ish to "flee" from an infected member of their family purely for self-protection: "But don't you have some kind of duty, or at least I think I do to look after that person" (F9 male, age 24). "What if it's a baby you've got to look after you can't do it can you? (F8 female, age 46). "P4: Well I wouldn't feel like just because you had the flu or a cold that I would have to P1: Stay away P4: Yeah have a different bedroom P1: No P4: I mean we would probably still share the same bed" (F5 P4: female, age 47, P1: female, age 61). "I wouldn't want them to feel like isolated, and like they you know they couldn't come out and like social- ise with us" (I3 female, age 19). The impeding nature of a close relationship seemed strengthened at the prospect of an outbreak of pandemic influenza. Participants stated they would be reluctant to keep away from loved ones if either they or their loved one were dying of pandemic influenza: "Oh man if you were dying I wouldn't, I'd like be at your side" (F10 female, age 24). The need for memory joggers was advocated with many participants stating that even if they did wish to imple- ment the measures they would most likely forget. This included, for example, handwashing timers to ensure hands were washed for an adequate length of time and adverts, posters or campaigns to remind people of the types of behaviours they should be undertaking. Indeed, many of the participants were not aware of the behaviours recommended to prevent the spread of colds and/or influ- enza between persons prior to participation in the study: "No one's ever told you when, not even your doctor's told you when you get a cold you should wash your hands a lot more than you usually do" (F6 male, age 23). Initiatives to improve understanding either at school, through doctors or in the media were considered valuable methods to facilitate implementation of the recom- mended behaviours. Practical difficulties such as access to the required facilities represented one of the most commonly cited barriers to implementation. The use and disposal of tissues for every sneeze or cough was seen as a challenge given that coughs Page 7 of 11 (page number not for citation purposes)