BMC Public Health 2009, 9:258 http://www.biomedcentral.com/1471-2458/9/258 and sneezes are most often a surprise with disposal facili- ties not always nearby: "P1: Yeah but would you be able to [wash regularly and decontaminate surfaces]? "P2: I still think your coughs, coughs and sneezes catch me by surprise P1: Yeah you can't, you can't P2: You're like that, or it's in your pocket or as you say you're in the living room by the time you've got to the toilet or wherever the tissue is you've done your load" (F6 P2: male, age 24, P1: male, age 23). Other physical barriers to the implementation of the rec- ommended behaviours included a lack of time to imple- ment frequent handwashing and bodily effects such as sore noses from frequent tissue use or sore hands from fre- quent washing. Despite all participants stating that it was possible for each member of their household to sleep in separate bed- rooms, a lack of adequate space to maintain social dis- tance was cited as a further practical barrier. This apparent contradiction appeared to be based on the assumption that the infected person would continue to be mobile. For example, several participants stated that maintaining social distance would not be feasible given the necessary, daily activities of the household e.g. eating, cleaning, moving between rooms etc. This assumed mobility may result from the perceived unacceptability of restricting an individual's movement within the household. As one par- ticipant states, a household represents "shared" space to which all members are entitled access: "so yeh it's not that practical, especially if they're just wandering around the house like you have to share living space" (I3, female, age 19) "I think it will still be quite practically hard if like the person that was infected chose just to walk around the house or flat like practically it's really hard to keep three feet away from them, maybe wait till they've walked out the corridor and just things like that" (F4, female, age 19) It seems that, at least in the context of non-pandemic colds and influenza, socially isolating members of a household contradicts the ethos of what a household should be; a shared, socially connected and 'free' house- hold. The impact of illness, for example fatigue or energy loss, was viewed as a significant barrier, particularly in the con- text of pandemic influenza: P2: That's what I'm saying I still don't know P4: Yeah somebody else would have to do it P2: You'd be too ill. (F8 P1: female, age 49, P2: female, age 44, P4: female, age 46). Maintaining implementation of all measures was consid- ered highly unlikely in the event of persistent or pro- longed illness. That said, all the participants concurred that if it was something very serious, such as pandemic influenza, they would be more determined to implement all of the infection control behaviours: "I think you know when it's life or death situations you're gonna do whatever is recommended" (F4 female, age 19). "If your life's at risk I think everyone would do it" (F6 male, age 23). Discussion In general, participants were knowledgeable about the transmission routes of colds and influenza, supporting the previous work of Vingilis et al. [20]. Participants were less knowledgeable with regard to pandemic influenza, its origins and the threat it poses. These findings are in line with Janssen et al. [32], who reported low concern for pandemic influenza amongst the general public in the United States. In the context of non-pandemic influenza, infection control behaviours were met with unfavourable attitudes. Specifically, participants felt that the behaviours may do more harm than good and/or were unnecessary. However, participants expressed a much greater willing- ness to carry out hygiene behaviours in the context of pan- demic influenza. Thus, participants reported that they were only likely to implement the recommended behav- iours in the event of a serious health threat, reinforcing previous research suggesting the importance of perceived personal risk [43]. That said, pandemic health threats with symptoms perceived as mild e.g. 'swine 'flu', may not result in widespread and consistent implementation of infection control behaviours. Moreover, habit is an important influence on routine behaviour [44] – includ- ing hygiene behaviour [31] – and despite their best inten- tions people may find it difficult to implement new hygiene measures during a pandemic if they have not pre- viously made these a habit. A common motivation for implementing the behaviours was to protect the health of others. This is consistent with the views of the older Chinese people during the SARS Page 8 of 11 (page number not for citation purposes)