Laypersons’ perception of common cold and influenza prevention—a qualitative study in Austria, Belgium and Croatia

Figures & data

Table 1. Participants’ characteristics.

Age, years	Austria	Belgium	Croatia
18–30	6	14	9
31–45	6	4	2
46–60	7	9	4
61–75	6	2	7
76+	6	1	2
Gender
Female	19	16	10
Male	12	14	14
Level of education
Higher education	2	16	11
Elementary/high school	29	14	13
Influenza vaccination in the year of interviewing
Yes	5	6	5
No	26	24	19

Box 1 Prevention of the common cold

Prevention of infection by hygiene measures	Avoiding contact with sick people/contaminated objects	‘Maybe I try to avoid contact with persons who show clear symptoms of flu-like diseases during these seasons.’ (A9) ‘I do not touch the things, the door handles and such, especially in public spaces. ‘ (A6) ‘Pay attention to what you drink from and with whom you come into contact.’ (B18) ‘I try not to get in contact with someone sick, if someone home is sick, we don’t really hug and kiss.’ (C7)
	Hand hygiene	‘Maybe I try, during these time periods, to avoid skin contact to surfaces that many people touch, and I possibly try to wash hands more often. If I, after I touched a surface such as, i.e. door handles and switches and other, I will try not to touch my face…’ (A19) ‘I wash my hands.’ (B6) ‘I wash my hands often…’ (C7)
	Ventilate/clean rooms	‘I am convinced that if you get it, that it is in the air, so that you have to open everything every now and then.’ (B12) ‘Cleaning the apartment more often…’ (C12)
	Avoiding larger groups of people	‘You should not attend larger crowds.’ (A21) ‘I generally avoid going to crowded places, more or less.’ (C19)
Strengthening the immune system	Healthy lifestyle	‘… during the autumn I pay attention that I eat a lot of vitamins, that I take in fruit sufficiently, which is not always easy.’ (A3) ‘I regularly go to the gym and also regularly to the sauna afterwards.’ (A29) ‘Try to live a healthy life. Sufficient sleep, sufficient exercise and good food.’ (B16) ‘… I think person’s general fitness, body constitution, maintaining physical fitness, in my opinion that is most important.’ (C4)
	Products based on plants/herbs	‘Oranges with honey, tea with honey, yes.’ (A23) ‘… drinking tea, and honey.’ (B7) ‘I heard about ginger, honey and lemon combination so I took that once…’ (C16)
	Vitamin supplements	‘… then I take Echinacea pastilles.’ (B1) ‘… sometimes I use vitamin pills.’ (B2) ‘… most often I prepare myself a lemonade at home, or I buy effervescent tablets with vitamin C.’ (C3)
Adequate weather wear, avoiding drafts/cold temperatures		‘How I protect myself … by not wearing light clothing when I go outside, when it’s cold or that I avoid draft.’ (A10) ‘… take into account that if I have washed my hair, that it is well dry before I go outside.’ (B15) ‘I dress according to the weather conditions, and I take care not to get in weather-temperature ‘traps’.’ (C10)
Don’t do anything		‘Actually I hardly change anything. In my opinion I have a relatively balanced diet, there may be possibilities for improvement, but I don’t follow a really super healthy diet, as I would wish for, that is why I don’t do much for it.’ (A11) ‘Either you are lucky or you are unlucky … well I don’t think you can protect yourself (note: from falling ill).’ (A31) ‘I seriously don’t need to protect myself … up till now my body was able to fight those things on its own.’ (C17)

Box 2 Prevention of the influenza

Prevention of infection by hygiene measures	Avoiding contact with sick people contaminated objects	‘What plays a role in my case maybe, that I got the flu less frequently was that I went with the car to work, therefore I hardly had contact … in public transport.’ (A29) ‘I avoid having contact with people I know have the flu, that’s for sure.’ (C2) ‘I do not use cutlery from someone with the flu, or drink from his glass.’ (B25)
	Hand hygiene	‘… I wash my hands more often, after buying groceries, or after I went somewhere.’ (A2) ‘When it’s flu season, I mostly wash my hands, when I’m at the doctors’ or something like that, I always wash my hands. I wouldn’t want to get infected, so I wash my hands because I know I’ll touch my face later.’ (C2)
	Ventilate/clean rooms	‘… it is important that you always ventilate everything well. If someone comes to us and I know they are sick, when they are gone, I will open everything for a quarter of an hour.’ (B10)
	Avoiding larger groups of people	‘I mean, it’s like they say, don’t go into enclosed spaces where there are people, as much as you can stick to that, you can easily catch it in a streetcar, or at work.’ (C16)
Strengthening the immune system	Healthy lifestyle	‘Well, the same way, I guess, like against the cold. Diverse nutrition, sports life….’ (C15) ‘Eating enough fruit to maintain your immune system, that’s the key I think, and yes, enough sleep.’ (B17)
	Vitamin supplements	‘… by taking some vitamin C….’ (B28)
	Taking other products to strengthen the immune system	‘I take homeopathic grains, with influenenzinum, which I always have, against the flu. I take them first every week, and then once a month as long as the flu is present.’ (B19)
Adequate weather wear, avoiding drafts/cold temperatures		‘I try to cover myself, a scarf or something.’ (B23) ‘Well, you should go about your normal activities, dress appropriately, so you’re comfortable, not too hot or too cold. That’s how I prevent the flu.’ (C10)
Vaccination		‘… an annual flu shot at the doctor’s office.’ (B14) ‘I get vaccinated against the flu … must be 15 years now … because I’m got other chronic conditions.’ (C5)
Don’t do anything		‘Independent of the influenza season I wash my hands often, not only when it’s the season.’ (A11) ‘I don’t do anything to protect myself, not even vaccination.’ (C20)

Box 3 Attitude towards influenza vaccination.

Reasons for vaccination	Fear of influenza/complications	‘I did not get influenza vaccination for so many years, but I took it for this year because well, and there is maybe this point in time, because I am retired for several years now, I now suffer again more often from the flu, while maybe that is the case when one becomes older….’ (A29) ‘If you are sick then it is more difficult to cure [without a vaccine]. Your resistance reduced. ‘ (B14) ‘I have to, since I had that bacterial pneumonia, I get vaccinated every year. I’m afraid of the flu, absolutely afraid. I think you should get vaccinated. I didn’t get it once since I started vaccinating myself. Not even a cold. Nothing.’ (C1)
	High risk for influenza (chronic patients, older people, health workers)	‘After I suffered my second stroke, the mister doctor said vaccination—every year. (…) And this is what I did and since then I have not had the flu and it has been 10 years since the second stroke.’ (A28) ‘The doctors then said that I was a risk patient for the flu because I had asthma and since then I started doing it every year.’ (B6) ‘I’ve been getting vaccinated for years now, because I’m a chronic patient.’ (C5)
	Health professionals recommendation	‘I got it prescribed [note: because of COPD].’ (A8) ‘…the doctor was a supporter of that.’ (B11) ‘But in terms of prevention, especially if you’re retired and older like I am, then it’s recommended to get vaccinated and I do it every year.’ (C10)
Reasons against vaccination	Perceived low influenza susceptibility, or low impact of influenza	‘I am strictly against it because I hear from everyone who got the influenza vaccination that they contracted something [note: an illness] and I didn’t.’ (A5) ‘I do not think that’s worth the effort. I cannot remember that I had the flu.’ (B7) ‘I think I’m not susceptible to flu and I don’t have to get vaccinated.’ (C4)
	Vaccination only for risk groups	‘I already heard about it and I have talked to my GP and he said he does not vaccinate people under 60 years. Because, he says, if you are not really ill or have a chronic disease then the body is strong enough to overcome the flu (…) I think the body should learn to fight (…).’ (A25) ‘If you are healthy, then you should not let yourself be injected with a disease-something.’ (B1) ‘I heard there were vaccines, but it’s mostly for older people and people who work in healthcare, they are much more in contact with persons that have the flu.’ (C9)
	Perceived vaccine ineffectiveness	‘My sister for example, she obtains the influenza vaccination every year, every year she has a heavy flu, every year a heavy flu, I say, why do you get the vaccination, what for? It has no use the vaccination. The best is to ‘sweat through’ it.’ (A13) ‘They told on the news that it does not work well, or that it is only one in two or something.’ (B2) ‘If you are vaccinated against the flu, you will get another variant.’ (B8) ‘Ultimately, I believe vaccines against viral infections to be quite ineffective. I mean, even if we get vaccinated against one virus, there is some kind of other strain that can cause the same consequences, and we never got vaccinated against it. I think it’s better to boost your immune system, than get vaccinated.’ (C13)
	Fear of vaccine side effects	‘I received the influenza vaccination once and then I got the symptoms of the flu and since then I don’t get it no more.’ (A16) ‘You are then vaccinated and you also hear from some people that they are sick of that vaccination.’ (B12) ‘In the US, the vaccines used here are banned because there is too much lead and mercury in them.’ (B21) ‘I’m not sure if I could achieve the opposite effect, by getting vaccinated.’ (C4)
	Contraindications to vaccination	‘I don’t get vaccinated because I am not allowed [note: suffers from a demyelinating disease]… Once I received the influenza vaccination, I was 17 … Then I was ill for three months.’ (A30)
	It is not a priority	‘Every year when I have the flu, I say: “shit, I really have to do that next year [Taking a vaccine]”, but I don’t. (…). It is a little bit human for sure, when you are sick, you say “I should have done it”, but then you forget. I’m called every year, but I have to go to X (city) for the vaccine, and I do not do that then.’ (B3) ‘To be honest, I make an appointment (to be vaccinated), but always something gets in the way so I never make it … usually something meaningless….’ (C3)
	Greater trust in homeopathic	‘Yes, what do they put in those syringes. (…) Just give me what nature gives and I think that’s worth my trust.’ (B19)
Reasons to get vaccinated it in the future	Advice of their doctor	‘… but then my doctor has to say “now it is needed”.’ (B9)
	Belonging to a risk group/increased risk of influenza	‘Yes, if you are old and have no resistance anymore.’ (B10) ‘Maybe I will when I’m sixty or something like that when it will be more critical than now, but so far I see no need.’ (C9)
	Protecting other people	‘If someone can have a disadvantage, I will do it immediately.’ (B13) ‘Probably when I have kids, their health will be important to me so I’ll probably start thinking of myself as well. ‘ (C12)
	Having influenza/contact with influenza frequently	‘… but I intend to because I think prevention is really important. What I’ve done so far was some kind of lottery because I’m frequently among people that have flu….’ (C3) ‘During my internship at a primary school, I talked about it and I heard that many teachers do so. So then I have thought about it that maybe I would do that later.’ (B2)
	Not becoming sick during an important moment	‘I would take a flu vaccine if it is an important period that is accompanied by a flu epidemic.’ (B4)