promotion of knowledge, attitude and practice towards swine flu a ...

Menofia Medical Journal 83 Promotion of Knowledge, Attitude and PracticeVol. 23 No . 2 July 2010Taghreed Farahat et al.,PROMOTION OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDSSWINE FLU A /H1N1; (AN INTERVENTION STUDY ON SECONDARYSCHOOL CHILDREN OF MENOFIA GOVERNORATE, EGYPT)TAGHREED FARAHAT*, MOHAMMAD AL-KOT*, OMAIMA ABOU AL-FATH**, ALAA NOH***AND NASHWA DIAB **Family Medicine Department,**Community Medicine Department,***Tropical Medicine Department, Faculty ofMedicine, Menofia University, Egypt.ABSTRACTBackground: Egypt had a higher number of swine flu (Novel Influenza A/ H1N1) in Eastern MediterraneanRegion. Satisfactory knowledge, positive attitude and healthful practice of people regarding swine flu are acornerstone in prevention of virus spread and disease outbreak. Objectives: The main objective was childhealth promotion, however the specific objectives were; to assess and improve knowledge, attitude andpractice (KAP) of school children towards swine flu in Menofia Governorate. Subjects and Methods: Thestudy was an interventional prospective study that was conducted during the academic year 2009/2010 on arandomly selected 420 secondary school children in Monshat sultan village and Menouf city representing theurban and rural areas of Menofia governorate respectively. The participant students were interviewed andinvited after their consent to fill a pre-designed closed-ended Arabic questionnaire before and 3 months afterimplementation of a health education program that addressed the important issues regarding Novel A/H1N1infection. Results: All studied school children heard about the disease as a name. The main source ofknowledge was TV (65.5%).The level of satisfactory knowledge, positive attitude and good practice ofstudied school children were significantly improved after implementation of the educational program whereits increased from 43.3%, 45% and 57.4% before intervention to 67.9%, 63.8% and 64.8% after interventionrespectively (P< 0.001).Logistic regression analysis showed that, higher paternal education, occupation andsocioeconomic levels were associated with higher scores of knowledge (Odds Ratio, 0.60, 0.54 and 0.51respectively). Conclusion and recommendations: The results reflected the importance of health educationas a cornerstone element in improving KAP towards influenza A/H1N1 infection. The study spots the lighton the need of continuous health education of students to improve their awareness, attitude and practiceregarding A/H1N1 preventing the virus spread and disease outbreak.Key words: Swine flu, Novel A/ H1N1, prevalence, outbreak, knowledge, attitude and practice.MMJ (July 2010) Vol. 23 N0:2:P 83– 94INTRODUCTIONSwine flu is an acute respiratory disease, causedby a strain of the influenza type A virus knownas H1N1, officially referred as novel A/H1N1[1]. The virus is a mixture of four knownstrains of influenza A virus: one endemic inhumans, one endemic in birds, and two endemicin pigs (swine). Swine influenza was firstproposed to be a disease related to humaninfluenza during the 1918 flu pandemic, whichwas known as Spanish flu, (infect about 500million people and caused approximately 50million deaths) [2]. At the end of March 2009,an outbreak of novel influenza A/H1N1infection occurred in Mexico, followed byongoing spread to all over the world in a shortperiod [1]. On 11 June 2009, the World HealthOrganization (WHO) raised its pandemic alertlevel to the highest one, phase 6 [2], meaningthat, the A/H1N1 flu had spread in more thantwo continents. On June, 2010, it had causedover 18,172 deaths in more than 214 countriesand overseas territories or communities [3]. InEgypt, according to the Ministry of Health, thetotal number of confirmed reported cases up toJune 2010 reached 16,372 cases [1]. Mostillnesses, especially the severe ones and deathshad occurred among healthy young adults [4, 5].

Menofia Medical Journal 84 Promotion of Knowledge, Attitude and PracticeVol. 23 No . 2 July 2010Taghreed Farahat et al.,The illness is generally mild except in people inhigh risk groups as pregnant women and peoplewith medical conditions like other influenzaviruses. A/H1N1 influenza spreads by coughing,sneezing, or touching contaminated surfacesfollowed by touching the nose or mouth.Transmission of the new strain is human-tohumanhowever eating cooked pork productswill not transmit the virus. Its symptoms aresimilar to those of influenza in general. Itincludes fever, cough, sore throat, body aches,headache, chills and fatigue. The 2009 A/H1N1outbreak has shown an increased percentage ofpatients reporting diarrhea and vomiting. Mostpeople who get influenza will recover in a fewdays to less than 2 weeks, but some people willdevelop complications such as pneumoniawhich may be life-threatening resulting in death[3]. The flu can make chronic health problemsworse. Vaccines are available for different kindsof swine flu. However, vaccines against the newstrain are being developed, with safety profilelike seasonal flu vaccine. Knowledge, attitudeand practice of people regarding swine flu are acornerstone in prevention of virus spread andoutbreak [4]. Objectives of the study: Themain objective was child health promotion.However the specific objectives were to assessand improve knowledge, attitude and practice(KAP) of school children in MenofiaGovernorate towards swine flu (InfluenzaA/H1N1).SUBJECTS AND METHODSType of the study: This work was a prospectiveinterventional study. Time of the study: Thestudy was conducted during the academic year2009/2010. Site of the study: Two secondaryschools, one from Menouf city and the otherfrom Monshat Sultan village. Both wereselected by a stratified multistage randomsampling technique representing the urban andrural areas of Menofia governorate respectively.Population of the study: The sample size wascalculated (at 80% power of the study, 95%confidence level and 5% level of significance)as 390 which were increased to 430 toovercome dropping out or invalid response.They were selected by a systematic randomsampling technique from the students' list asevery 3 rd one. Only 420 students completed thestudy .Tools of the study: 1- A closed endedArabic questionnaire was designed to collectinformation about: A-Personal data e.g.: Age,sex…etc. B-Socioeconomic status, that wasclassified to high, middle or low according tosocio-economic scoring system of Abd Al-Twab[5].C- Source of information about NovelA/H1N1.D-knowledge towards A/H1N1 e.g.:Causative agents, Mode of transmission ….etc.E- Attitude e.g. If he is worry from gettinginfection, afraid from vaccination …etc. F-Behaviors regarding infection control as regardswashing hands, covering nose and mouth duringcoughing or sneezing …etc. The samequestionnaire was used as a pre and post test,before and three months after implementation ofthe health education program 2- Healtheducation program: Aim of the program: Theprogram was implemented to improveknowledge, modify the attitude and correct thepractice of the participants regarding influenzaA/H1N1.Program implementation: All the selectedstudents were first interviewed in the brakewhere the study methodology and objectiveswere simply discussed to obtain their consent.They were subjected to a previously designed

Menofia Medical Journal 85 Promotion of Knowledge, Attitude and PracticeVol. 23 No . 2 July 2010Taghreed Farahat et al.,questionnaire to assess their knowledge, attitudeand practice towards swine flu. Then, they weregiven an appointment to attend the healtheducation program. Sessions place and timeschedule: The program was held every otherday for 2 weeks in the library room of eachschool. Main topics of the program: Theparticipants were given intensive theoreticalcourse about Influenza A\H1N1 with specialemphasis on causative agent, mode oftransmission, clinical picture, complications,prevention and management. Teachingmethods: The program was presented aslectures, role-play and group discussion.Teaching aids: Photos, posters, pamphlets anddata show. Evaluation of the program: Theprogram was evaluated three months later on bypost test using the same pre test questionnaire.Ethical issues: The program was ethicallyoffered to non participant children at the end ofthe study.STATISTICAL ANALYSISThe results were collected, tabulated andstatistically analyzed by a personal computerusing SPSS soft ware program (StatisticalProgram for Social Science), Version14 underWindows XP. Quantitative data were expressedas mean and standard deviation. Qualitative datawere expressed as number and percentage. Toassess the differences in frequencies on thedichotomized qualitative variables (scoredpresent or absent) Chi- Square test (χ 2) wasused with 5 % level of significance .Odds ratiousing logistic regression analysis: describe theprobability that people who are exposed to acertain factor will have high KAP compared topeople who are not exposed to that factor. Z test(z) was used to study the association betweentwo qualitative variables within different groupsin pre and post - tests.RESULTS AND DISCUSSIONAlthough Novel Influenza A/H1N1 has causedpandemic this century, there were a greatshortage in studying KAP of Egyptianpopulation regarding the disease until now.Therefore, we conducted this population-basedsurvey to investigate and promote a vulnerablecommunity group response to Influenza A/H1N1to protect them from contracting the infectionand provide baseline data for governmentalpreventive measures. This study differed fromprevious studies as it was conducted during theinfluenza A/H1N1 pandemic, when manyparticipants reported experience for seasonalinfluenza and /or flu. Therefore, we believe that,its results might more likely represent the actualresponse of the participants. In this study,100%of the participants knew swine flu as a namewhich may be attributed to the greet dilemmamade by the mass media while in a study done inIndia [6], only 83.1% had heard about thedisease. In this study 64% of the participants gottheir knowledge from TV, while 11% fromnewspapers. This was in agreement with a studydone among the Saudi public where majority ofthe participants (84.2%) received theirinformation from the television [7]. In this study84.5% of participants knew that, the disease wasa viral illness, however, in an Indian study [6]only 18.2% knew that, swine flu was caused by avirus. This study showed that, 44% of studentsknew that, sneezing is the main mode oftransmission, while 41.9% consider kissing andshaking hands. The study demonstrated that,30.7% of participants knew that cough, sorethroat, runny or blocked nose are symptoms ofswine flu while 69.5% suggested high fever.

Menofia Medical Journal 86 Promotion of Knowledge, Attitude and PracticeVol. 23 No . 2 July 2010Taghreed Farahat et al.,This study found that, 60.5% of participants hadgood cough and sneezing etiquette practicewhich was high compared to only one third in astudy done in Saudi Arabia [7]. In a study donein Australia [8], 46.6% reported frequent handwashing, but covering nose and mouth duringcough and sneezing was reported by only27.8%.Pertaining to prevention of infection only14.3% answered correctly on the need of usingface mask to prevent contracting or spreadingthe infection. This percentage was much lowerthan results from Saudi where 56% of theirparticipants used face mask in crowded areas [7].Adherence to face mask usage might be aproblem in our community as it was not acommon practice. Respondent’s income mayplay a role because majority of the participantswere from middle and low income group thusbuying face masks may incur a financial burdenfor them. However, community use of face maskis not an effective way of controlling seasonalinfluenza but adherent to mask usage amongexposed groups. This study found that, 51.7% ofparticipants considered frequent hand washing asa simple effective preventive measure. Thisfinding was in agreement with the previous workby Balkhy et al., in Saudi [7].The studydemonstrated that, 31.9% of participants believethat, staying at home when infected until cured isbetter. However, 66.2% necessitate medicalconsultation and sometimes hospitalization. Thestudy showed that, 51.7% wash their hands morefrequently especially after shaking hands withothers as a simple effective preventive method.However, 39.2% suggested keeping away fromcrowded places. In the Indian study [6], 52.6%of participants avoided crowded places and54.6% washed their hands with soap and watermore often than usual. In this study, 63.3% ofthe participants avoid touching or shaking hands.While in a study in Haryana, India during 2009pandemic [9], 40% of participants were avoidingcontact with people who appeared sick and60.5% of the participants used tissue orhandkerchief while sneezing, coughing orvisiting swine flu infected area. In our study,66.2% of the participants thought that, theyshould seek medical advice if developed any ofswine flu symptoms .These results were less thanthat of the Indian study [9], where 94% ofparticipants thought that, if they had developedthe symptoms of swine flu, they would havecontacted the swine flu centre immediately fordiagnosis. There are regional differences in theperception of Influenza A/H1N1, for example;the public in Hong Kong did not perceive a highlikelihood of having a local outbreak [10], butMalaysians were particularly anxious about thepandemic [11]. The current study showed that.emotional distress was relatively mild as fewchildren worried about being infected(31.2%).As regard vaccination, 29.8% ofparticipants have no idea about vaccination,31.6% said that, it is effective while 38.6%considered that, it had many side effects. Noneof participants received vaccination for 2009A/H1N1 influenza. This finding was consistentwith previous studies suggesting that, peoplewere reluctant to vaccinate themselves and theirchildren. These studies also demonstrated that,like our results, the major reason for refusing thepandemic vaccine was safety concerns,especially when people believed that, thevaccine went through an accelerated approvalprocedure [12]. Regarding a study done onuniversity students in Turkey [8], 92.8% statedthat, they were unwilling to be vaccinatedagainst influenza A/H1N1 while only 7.2% of

Menofia Medical Journal 87 Promotion of Knowledge, Attitude and PracticeVol. 23 No . 2 July 2010Taghreed Farahat et al.,participants said that, they would be while26.4% refuse the vaccination considering itunsafe. Logistic regression analysis resultssuggested that the participants with highereducational level, socioeconomic status andprofessional and governmental work had higherlevel of satisfactory KAP regarding A/H1N1infection, but not for gender or residency .TheSaudi study [7] showed that, older men withbetter education were more likely to takepreventive practices. In another pandemic studyin USA, younger people were found to havegreater uptake of recommended behaviors butnot for gender [13]. In our study there wasstatistically significant increase in the level ofgood knowledge, positive attitude and healthypractice after implementation of the program.This was in agreement with a study in Taif,Saudi Arabia, which found that, health educationis needed to increase students' awareness andpromote the health consciousness for preventionof disease at any level [14]. Also, Whitley andMonto [15] stated that, health education is animportant tool to reduce prevalence of thedisease. In addition, Al-Shehri et al., [14]demonstrated that, the role of health education inmodern world is increased with the goal toprovide the individuals with information, skillsand motivation necessary to make intelligentdecisions concerning life style and personalhealth behavior.CONCLUSION AND RECOMMENDATIONSInfluenza A/H1N1 epidemic has not causedpublic panic yet. This survey could be used asbaseline data to monitor public perceptions andbehaviors. As highlighted by this study, familyhealth centers and clinics should take theopportunity and maximize their effort in givinghealth education to their people as they arenearer to their own community with the help ofdifferent mass media especially T.V.REFERENCES1- Girard, M., Tam, J., Assossou, O. andKieny, M.: The 2009 A/H1N1 influenzavirus pandemic: A review. Vaccine. (2010);28(2): 4895-4902.2-World Health Organization (WHO):"Pandmic (H1N1)2009 –update " DiseaseOutbreak News (WHO). (2010); 14 May.3-Center for Disease Control and Prevention.(CDC) a ; Novel Swine-Origin Influenza A/H1N1 Virus Investigation Team, CDC."Emergence of a Novel Swine-OriginInfluenza A/H1N1 Virus in Humans." NEngl J Med .(2009);9(2): 2605-26015.4-Center for Disease Control and Prevention(CDC) b . "CDC Advisors MakeRecommendations for Use of VaccineAgainst Novel H1N1". Press release.Retrieved (2009).5- Abd Al-Twab, A.: Family socio-economicstatus scale, revised edition, MD. Thesis ineducational basics, faculty of education,Assiut University, Egypt. (2004).6-Kamate, S., Anil, A., Harshvardhan, C.,Karanprakash, S. and Prashant, M.;"Public knowledge, attitude and behavioralchanges in an Indian population during theInfluenza A (H1N1) outbreak." J Infect DevCtries. (2010); 4(1): 007-014.

Menofia Medical Journal 88 Promotion of Knowledge, Attitude and PracticeVol. 23 No . 2 July 2010Taghreed Farahat et al.,7-Balkhy, H., Mostafa, A., Rawabi, H. andMohammad, A.; "Awareness, attitudes, andpractices related to the swine influenzapandemic among the Saudi public". BMCInfect Dis. (2010);8(2): 30- 42.8- Osman, H. ,Akan, H., Yesim, G. , Guldal, I., Sukran, O. and Gulden, Y.:"Knowledgeand attitudes of university students towardpandemic influenza: a cross-sectional studyfrom Turkey." BMC Public Health. (2010);4(1): 027-034.9-Kumar, N., Sood, S., Singh, M., Kumar, M.,Makkar, B. and Singh, M.: "Knowledge ofswine flu among healthcare workers andgeneral population of Haryana India during(2009) pandmic" AMJ (2010); 3(9): 614-617.10-Lau, J., Griffiths, S., Choi, K. and Tsui,H.: Widespread public misconception in theearly phase of the H1N1 influenza epidemic.J Infect. (2009); 59(3): 122-127.12-Torun, S., Torun, F. and Catak, B.:Healthcare workers as parents: attitudestoward vaccinating their children againstpandemic influenza A/H1N1. BMC PublicHealth. (2010); 10: 596-604.13-Blendon, R., Benson, J., DesRoches, C.,Raleigh, E. and Taylor, K.: The public’sresponse to severe acute respiratorysyndrome in Toronto and the United States.Clin Infect Dis .(2004); 38(7): 925-931.14-Al-Shehry, A., Abdel-Fattah, M. andHifnawy, T.: “Knowledge and Concernsabout Avian Influenza among SecondarySchool Students in Taif, Saudi Arabia”.Eastern Mediterranean Health Journal.(2006) ; 12 (2): 178 -188.15-Whitley, R. and Monto, A.: "Prevention andtreatment of influenza in high-risk groups:children, pregnant women, immunecompromisedhosts, and nursing homeresidents." J Infect Dis. (2006);194-202.11-Goodwin, R., Haque, S., Neto, F., Lynn, B.and Myers, L.: Initial psychologicalresponses to Influenza A,H1N1 ("Swineflu”). BMC Infectious Diseases. (2009);9(2): 166-176.15%10% 11%64%TVInternetSchool matesNewspapersFigure (1): Source of knowledge of the studied students regarding swine flu.

Menofia Medical Journal 89 Promotion of Knowledge, Attitude and PracticeVol. 23 No . 2 July 2010Taghreed Farahat et al.,Table (1): Socio- demographic characteristics of the studied students.Socio- demographic criteria of studied Students (No. 420)Age: (Mean ±SD) 15.80 ± 2.92SexMaleFemaleNo. %19446.222653.8ResidenceUrbanRuralFathers' educationUniversitySecondaryBasicIlliterateFathers' occupationUnskilled workerSkilled workerEmployeeProfessionalMothers' educationUniversitySecondaryBasicIlliterateMothers' occupationHouse wifeUnskilled workerEmployeeProfessionalSocioeconomic levelHighModerateLow2211997312811010918011610222631389212718912610232317821952.647.417.430.526.225.942.927.624.35.215.032.921.930.245.030.024.30.75.542.352.2

Menofia Medical Journal 90 Promotion of Knowledge, Attitude and PracticeVol. 23 No . 2 July 2010Taghreed Farahat et al.,Table (2): Knowledge of the studied students regarding swine flu before and three months afterimplementation of the health education programKnowledge of students* regarding swine flu"Pre -intervention(No. 420 )Post - intervention(No. 420 )Z testP valueYes % Yes %Hearing about swine flu 420 - 420 -Presence of cases in Egypt-Yes- No- I do not know320455576.210.713.140112795.52.81.77.934.436.18

Menofia Medical Journal 91 Promotion of Knowledge, Attitude and PracticeVol. 23 No . 2 July 2010Taghreed Farahat et al.,Table (3): Attitude of studied students regarding swine flu before and three months afterimplementation of the health education programAttitude regarding swine flu*If the disease is dangerousYesNoPre - intervention(No. 420 )Post - intervention(No. 420 )No % No %30511572.627.435466χ 2Pvalue84.315.7 16.91

Menofia Medical Journal 93 Promotion of Knowledge, Attitude and PracticeVol. 23 No . 2 July 2010Taghreed Farahat et al.,Table (5): Knowledge, Attitude and Practice (KAP) scores of studied children before and afterimplementation of the health education programKAP ScoresKnowledge:SatisfactoryunsatisfactoryAttitude:PositiveNegativePractice:GoodPoorParticipants (N0. 420)Pre testPost testχ 2P valueNo. % No. %18243.3 28567.923856.7 13532.1 51.16

مقدمةMenofia Medical Journal 94 Promotion of Knowledge, Attitude and PracticeVol. 23 No . 2 July 2010Taghreed Farahat et al.,*تعزيز المعرفة والاتجاه والممارسة نحو إنفلونزا الخنازير(‏ دراسة تدخليه على طلاب المدارس الثانوية فى محافظةالمنوفية بمصر)‏********اد/تغريد محمد فرحات,‏ اد/أميمه محروس,‏ اد/علاء نوح,‏ د/محمد محمود القط,‏ ط/نشوى ديابقسم طب الأسرة*****, قسم طب المجتمع-‏ قسم المتوطنة – آلية الطب – جامعة المنوفيةيعتبر مرض إنفلونزا الخنازير من أمراض الصدر الحادة الناتجة عن الإصابة بفيروس الإنفلونزا من النوع أ والمعروف باسمH1N1‎ والمشار لهوالذي عرف بالإنفلونزا الأسبانية ‏(أصابتوقد عرف عنه قدرته على إصابة البشر منذ اجتياح عامعلميامليون وتسببت في وفاة حوالي 50 مليون شخص)‏ وقد حدثت بداية العدوى بإنفلونزا الخنازير H1N1 فى المكسيك بنهاية مارس‎2009‎ ثم انتشرتفى جميع أنحاء العالم في فترة وجيزة وفى 2009 قامت منظمة الصحة العالمية برفع درجة الإنذار إلى الدرجة القصوى ‏(المرحلة السادسة)‏وهذا يعنى أن انفلونزا الخنازير انتشرت في أآثر من قارتين من العالم وفى مصر بلغ العدد الكلى للحالات المبلغ عنها حتي يونيو 2010 من قبل وزارةوينتشر هذا الفيروس من شخص إلى آخر عن طريق الكحة والعطس ولمس الأسطح الملوثة بينما لا ينتقل عن طريق أآل لحمالصحةالخنزير وتعتبر أعراض هذا المرض مشابهة للانفلونزا العادية وتشمل ارتفاع الحرارة والكحة والتهاب الحلق وآلام العظام والصداع,‏ وتعتبر معرفةالناس بالمرض واتجاهاتهم وممارساتهم نحوه حجر زاوية في منع انتشاره والحد من تفشيه.‏5001918 ميلادية,11 يونيوNOVEL A/H1N116372 حالة ,أهداف الدراسةالهدف الأساسي هو تعزيز صحة طلاب المدارس من خلال تحسين المعرفة والاتجاهات والممارسات لدى طلاب المدارس فى محافظة المنوفية فيالتعامل مع انفلونزا الخنازير لمنع حدوثها والحد من انتشارها.‏الأشخاص وطرق البحث2010-2009 آدراسةتدخليه بمدرستان ثانويتان تم إختيارهما بطريقةأجريت هذه الدراسة على 420 من طلاب المدارس الثانوية أثناء العام الدراسيعشوائية إحداهما فى مدينة منوف والأخرى في قرية منشأة سلطان لتمثلا المناطق الحضرية و الريفية لمحافظة المنوفية على الترتيب وقد تم تصميماستبيان باللغة العربية لتجميع المعلومات الشخصية مثل الاسم و السن و الجنس والحالة الاجتماعية ثم جمع المعلومات عن انفلونزا الخنازير مثل السببوطرق العدوى و الأعراض و العلاج والوقاية وقد تم صياغة برنامج تثقيفى لتحسين المعرفة وتصحيح الاتجاه والاعتقاد وتغيير سلوك المشترآين تجاهذلك المرض.وقد تمت مقابلة الطلاب لشرح طريقة الدراسة ببساطة لأخذ موافقتهم حيث تم توزيع الاستبيان بين الحصص الدراسية لقياس مدىمعرفتهم وإتجاهاتهم وممارساتهم تجاه مرض انفلونزا الخنازير ثم تم إعطائهم ميعاد لحضور البرنامج التثقيفي حيث تم إعطاء المشارآين جلساتنظرية مكثفة عن انفلونزا الخنازير فى شكل ندوات و ورش عمل استخدمت فيها الصور و الملصقات وعروض الفيديو و قد تم تقييم البرنامج بعد ثلاثهشهور عن طريق استخدام نفس الاستبيان وأخلاقيا تم تقديم البرنامج في نهاية البحث لمن لم يشترك من الطلاب.‏النتائج والمناقشة.٪69,5بالرغم من أن انفلونزا الخنازير تسببت فى اجتياح العالم هذا القرن إلا أنه وجد قصور شديد فى دراسة المعلومات والاتجاهات والسلوك بين المصريينحتي الآن.لذلك أجرى هذا المسح لفئة حساسة من المجتمع بهدف حمايتهم من التقاط العدوى.وتختلف هذه الدراسة عن الدراسات السابقة حيث أنهاأجريت خلال الاجتياح الأخير للمرض و قد تبين من الدراسة أن ٪100 من المشارآين سمعوا عن مرض إنفلونزا الخنازير آاسم وهذا ناتج عنالضجة الإعلامية الكبيرة التى صاحبته و تبين أن‎64‎‏٪من المشارآين جنوا معلوماتهم من التلفزيون و‎٪11‎ من الجرائد آما تبين أن ‎84,5‎‏٪منالمشارآين يدرآون أن المرض فيروسي و ٪44 من الطلاب يعرفون أن العطس أآثر طريقة لانتشار العدوى بينما اعتبر ٪41,9 أن التقبيل والتصافحهو الأساس فى نقله.وقد أظهرت الدراسة أن ‎30,7‎‏٪من المشارآين أشاروا إلى أن الكحة والتهاب الحلق ورشح الأنف أو انسدادها من أهم أعراضالمرض بينما توقع ارتفاع درجة الحرارة وقد تبين من الدراسة أن ٪51,7 من المشارآين اعتبروا تكرار غسيل الأيدي وسيلة وقائية بسيطةومؤثرة وأظهرت هذه الدراسة أن ٪31,9 من المشارآين يعتقدون أن البقاء في المنزل عند الإصابة وحتي الشفاء هو الأفضل ولكنإلي ضرورة الاستشارة الطبية وأحيانا الحجز بالمستشفيات ‏.وأظهرت هذه الدراسة أن اقترحوا البعد عن الأماآن المزدحمة وقد أظهرتالدراسة أن قليل من الطلاب‎31,2‎‏٪آانوا قلقين من إصابتهم بالمرض وبالنسبة للتطعيم آان ‎29,8‎‏٪من المشارآين لا يعلمون عنه شيئا و‎٪31,6‎ قالوا أنهمؤثر و‎٪38,6‎ أبدوا تخوفا من آثاره الجانبية الكثيرة وفى هذه الدراسة آان هناك زيادة ذات دلالة إحصائية في درجة المعرفة و الاتجاهات الايجابيةوالسلوك الصحيح بعد ثلاثة أشهر من تلقى البرنامجالتوصيات٪66,2 أشاروا٪39,2تقدم هذه الدراسة قاعدة بيانات أساسية لدرجة وعى واتجاهات وسلوك مجموعة حساسة من المجتمع وهم طلاب المدارس وتشير نتائج الدراسة الىضرورة أن يأخذ أطباء الأسرة الفرصة مع دعم جهودهم في التثقيف الصحي وتوعية المجتمع نحو آيفية الوقاية والعلاج من مرض إنفلونزا الخنازيرلأنهم أقرب الي مجتمعاتهم مع ضرورة مساعدة آافة وسائل الإعلام وخاصة التلفزيون.‏