Influenza is a recurrent public-health issue, and there is considerable information on influenza from an epidemiological point of view. Community subjects’ knowledge of preventive measures has dramatically increased since the occurrence of the H1N1 pandemic, although there is still a gap between scientific information and every-day life
. Little information is available regarding lay people’s representations of influenza and of how it may affect them in their day-to-day lives.
An English study, conducted in the 1970s, showed that patients think that colds occur when vulnerable parts of the body (e.g., feet, head, chest) are exposed to cold temperatures, humidity, or cold air currents
. In a US study, parents tended to find an association between the weather changes and the incidence of their children's colds
. Although information is available regarding people’s knowledge about avian flu and its prevention, there is little information on how preventive measures, e.g., wearing a mask or the need for social distance, are endorsed by community subjects
Flu-vaccination issues provide some information concerning people’s views. A qualitative study in people aged > 65 years demonstrated that, for these subjects, the risk of contracting flu was considered very low, with no consequences of the vaccination on this probability. Also, if they caught flu, they did not expect any serious consequences
. This feeling of the unlikeliness of contracting this disease was also reported in an Australian study that focused on the H1N1 pandemic
. Qualitative studies show that, in a non-pandemic context, few people expressed favorable opinions about control behaviors or were ready to adopt avoidance actions, and they questioned the effectiveness of vaccination, even in a pandemic context
[7, 8]. As Gray et al. stressed
, “It is important to accommodate the fact that disbelief in the effectiveness of measures can result in people failing to act and developing distrust of sources of information”. Similarly, a French qualitative study, conducted on a group of patients with cystic fibrosis, a high risk population for severe flu infection, emphasized the role of information sources in these patients in deciding to accept or refuse the H1N1 vaccine. Those who refused the vaccine mentioned receiving multiple and indecisive information, whereas those who accepted the vaccine reported having received unequivocal advice from their healthcare provider
. Globally, results from these qualitative studies emphasize that the public need to receive transparent and factual information about the specific actions to be take, and this should be provided by people they can trust
These data question the representations that people have about this disease and the congruence of these representations versus scientific definitions. Influenza (or flu) is a contagious viral infection caused by influenza viruses, which mainly affects the nose, throat, bronchi, and, occasionally, the lungs. The combination of fever or other systemic symptoms, plus respiratory signs, defines an influenza-like illness (ILI). Influenza viruses can cause ILI, but not always: ~30% of influenza infections are not associated with any symptoms, and another ~30% will not cause a fever. Thus, only ~30% of influenza infections correspond to ILI
. In contrast, not all ILIs are caused by influenza viruses: many other respiratory pathogens can cause the same type of illness. In temperate countries, the likelihood of having the influenza virus in a patient with an ILI varies from 0% (when no influenza virus is circulating in the community, e.g., in summer) to 60–70% when there is intense circulation (e.g., during seasonal epidemics). Of note, vaccination or specific antiviral therapies will only prevent or treat infections and illnesses (mild or severe) caused by the influenza virus: i.e., they are not effective against all ILIs.
Peoples' representations consist of socially constructed and shared knowledge based on experiences and models of thoughts spread via education and social communication
[12, 13]. As a form of practical knowledge, representations help understanding and explaining our universe. Patients' representations of flu are an important aspect of the patients' decision-making processes regarding treatment and their perceptions of treatment
. These prior elements influence the way that people organize new information (i.e., whether to incorporate it with existing knowledge or to discard it)
Anthropological studies suggest two groups of representations of the disease in the public health and social field
. The "majority model" views the disease as an exogenous entity that enters the body of an individual who carries no responsibility or control over the process. Healing is viewed as suppressing a hostile condition that must be annihilated. This "majority model" mainly draws from the biomedical model which considers the etiology and symptoms of the disease when choosing a treatment. The second model considers disease as an endogenous entity and healing as a regulating activity that takes into account, rather than opposes, the symptoms of the disease. This model stresses the role of the patient in curing him- or herself.
Taken together, these elements suggest a possible gap between scientific and lay knowledge, with both forms of knowledge having different aims. While scientific knowledge describes general patterns of disease common to all individuals and statistically appraisable, lay knowledge tends to personalize the illness by including the individual’s suffering and then contextualizes it
. In the scientific model, flu and ILI dictate various strategies of prevention and treatment according to the patient's medical history, age, etc. However, lay people’s representations regarding flu and ILI, as well as attitudes and behaviors related to its symptoms, have received little research. This issue is of importance as it is a seasonal problem, and public-health authorities and clinicians involved in day-to-day management of disease have to elaborate and try to implement strategies directed at informing various groups within the population about the disease, its risks, and possible preventive interventions.
Based on these observations, we carried out a qualitative analysis designed to improve our understanding of people’s representations of flu and ILI in France. Indeed, a better insight into the sorts of views people hold about flu and ILI, as well as how they plan to cope with its symptoms, is particularly relevant as influenza is a highly recurrent disease.