Research type 
Year of report 

Summary of findings


1. Approach to health

Attitudes to health and the NHS varied across the sample and a number of attitudinal clusters emerged from the BME sample 

‘In Controls’

  • This attitudinal cluster mainly consisted of parents aged between 25 and 45
  • Indian, Black African, Black Caribbean and Chinese men and women, and Pakistani men; It also included some Somali, Bangladeshi and Pakistani parents born and/or brought up in the UK
  • They tended to take a proactive stance to their overall health and people were focused on trying to follow healthy diets, being active and taking preventative measures such as ensuring general good hygiene to avoid getting ill
  • ‘In control’ respondents appeared to have good access to information about health issues through various mainstream channels and were generally confident about getting information and checking health advice for themselves
  • Feedback suggested there was trust in the NHS and the medical profession, but this was not their first port of call for less serious ailments. They were more likely to self medicate or to use traditional home remedies before seeking the advice of their GP


  • Mainly men and women aged 46 and over from the Bangladeshi, Pakistani, Chinese and Indian communities, and Black Caribbean and Black African women over 46
  • Also included some younger UK born and/or brought up Bangladeshi men, Bangladeshi and Pakistani women and some younger Somali men
  • Typically less proactive than the ‘in controls’, as they appeared to take less personal responsibility for their own health in terms of actively following healthy lifestyles to avoid illness
  • However, people were generally open minded and interested in learning about how to stay healthy
  • Health professionals indicated that there was some willingness to try over-the-counter medication and home remedies amongst this group before seeking medical advice
  • However, ‘followers’ did expect treatment from GPs once medical assistance was sought even for relatively minor illnesses
  • Tended to place a great deal of trust in the medical profession

‘Disconnected Passives’ 

  • Mainly applied to people over the age of 46 from the Somali, Bangladeshi and Pakistani samples and some younger people born and brought up abroad
  • Health professionals particularly reported seeing patients of this type
  • Appeared quite reactive in their approach to health and less focused in discussions on taking preventative health measures
  • GPs reported many patients arriving at their surgeries for relatively minor ailments, expecting to receive medication for such conditions
  • A number of doctors also felt that patients tended to focus on non-chronic illnesses with obvious and immediate symptoms rather than on chronic but less obvious conditions
  • As a result, although there was high demand for medication from this group, GPs faced problems with non-compliance of medication and lifestyle 
  • Some older people were also fatalistic about their health, believing that health outcomes were in the hands of God, and therefore not within their control. This could explain the lack of willingness to make behavioural changes that could help ensure more positive health outcomes
  • Generally had poor levels of English and more limited awareness of health issues
  • Little motivation or confidence in seeking information for themselves. Those with some awareness of health prevention information did not always feel able to translate this into specific preventative behaviours

‘Disconnected Cynics’ 

  • Consisted of mainly Black African and Black Caribbean men over the age of 46
  • Tended to take a more ‘laissez faire’ approach to health, avoiding going to the doctor unless they felt they were seriously ill. As a result, they were more likely to underplay any symptoms
  • Generally, interest in health issues was fairly limited
  • Expressed more negative views about the health profession and were more mistrustful of the NHS than others
  • Whilst most were generally aware of health issues reported in the media they were less interested in finding out more for themselves

2. Awareness of and attitudes to the swine flu pandemic 

Across the sample, awareness of the pandemic was relatively high. However, understanding of the virus in terms of differences with seasonal flu, how it is contracted, prevention and courses of action to take if contracted varied across the four attitudinal clusters. 

‘In Controls’ 

  • These mainly younger people were highly knowledgeable about the pandemic in terms of how it is transmitted, the high risk groups, what preventative behaviours could reduce the risk of the virus and what actions to take if contracted (i.e. staying at home and taking over-the-counter medication unless they had underlying health conditions)
  • The importance of good respiratory and hand hygiene in reducing the risk of the virus was well understood and deemed to be already practiced by this group
  • They also felt confident in enforcing good practice amongst their relatives
  • This group was also aware of the current swine flu treatment although most were negative about using Tamiflu due to concerns about safety and, amongst those with experience of swine flu, perceived negative experiences of the antiviral
  • Access to swine flu information in mainstream media and the DH's communications were high
  • Many had also been seeking online information via the National Pandemic Flu Service, NHS Direct and NHS 24 (Scotland)
  • This group felt well informed about the pandemic. As a result, initial concern about the pandemic had, to some extent abated, although concerns were expressed about the swine flu vaccination, particularly amongst pregnant women


  • Some levels of awareness and knowledge of the swine flu virus was evident, mainly from news coverage in mainstream and ethnic media, word-of-mouth from relatives, health professionals and information received from schools
  • There was some understanding of prevention measures, but this was patchy. For example, people talked about the need to avoid exposure to the virus outside the home but were less focused on what behaviours could limit the risk within the home
  • Some Muslims believed that they were less at risk because they did not eat pork
  • Respiratory and hand hygiene practices varied amongst this group. Some tended to focus on good practices for their children but less so for themselves. Also, their focus tended to be on RHH amongst the general public rather than on the individual
  • As a result, hygiene practices in the home were less front of mind than the avoidance of crowded places
  • Understanding of the direct link between the benefits of good RHH in reducing the risks of swine flu was inconsistent
  • People generally understood what actions to take if they contracted the virus and said they would stay at home and contact their GP by telephone if they were a high risk group. However, some people who had been affected by swine flu did visit their GP or hospital because of concerns about the severity of the illness as they felt they needed medical reassurance
  • Some knew that a treatment of the virus was available but not many were familiar with the term 'antiviral'
  • Concern about the pandemic remained amongst this group. As many had underlying health problems, there was anxiety about the actual personal risk of contracting the virus and how severely they might personally be affected 

‘Disconnected Passives’ 

  • Some basic awareness of swine flu as a current health issue existed from a range of sources including leaflets from schools, health professionals, specialist ethnic media and word-of-mouth
  • However, there was limited understanding of how swine flu differed from seasonal flu, how the virus is contracted, the high risk groups and prevention behaviours. In particular, how germs can spread the virus was less clearly understood
  • A few people were unfamiliar with the term ‘swine’ and some Muslims in this group felt they were not at risk because they did not eat pork
  • Good RHH was not always a front of mind priority for many and this was supported by observations made by health professionals
  • There was limited understanding of the link between RHH and the transmission of the virus. Whilst the spread of airborne germs was understood by some, not all knew how germs could be transmitted from surfaces
  • A number of specific barriers to good RHH practices were identified: some people felt it would be hard to enforce good RHH practices amongst elders in the family; a few were less familiar with sanitising hand gels; using hand gels was prohibitive for some Muslims because of the alcohol content; the cost of tissues was suggested by health professionals to be an issue for some people
  • There was some awareness of the need to remain at home if the virus was suspected, but a few of those with direct experience of the virus had visited their GPs and Accident and Emergency (A&E) hospital departments despite advice 
  • Knowledge of treatment was limited and few had heard of antivirals or Tamiflu. Despite this, expectation of treatment in the event of contracting the virus was high
  • Many remained concerned about the pandemic because they did not feel they knew enough about the virus nor had sufficient knowledge about treatment and prevention

‘Disconnected Cynics’ 

  • This group claimed to have limited knowledge about swine flu, beyond it being a serious and potentially fatal illness and this was mainly from coverage in both mainstream and ethnic targeted media
  • However, little interest was expressed in finding out more or getting further information
  • It was assumed that the elderly were more at risk of contracting the virus, but people did not necessarily see themselves as being at risk, even those with underlying health conditions
  • Most claimed that they would not know what to do if they thought they had caught the virus. This reflects their general lack of thought about the issue
  • However, some said that their first port of call could be their GP, but only if their symptoms were serious enough to warrant some action on their part
  • Respondents generally were not aware of any treatments for swine flu. Most said that they were not sure how the illness is treated and when specifically asked, most claimed that they had not heard of Tamiflu or antivirals
  • There was some claimed good RHH behaviour and people referred to good hygiene as an everyday practice that did not require much thought
  • However, discussions suggested that actual RHH behaviour was not as positive as claimed. A few admitted that their families had tried to encourage them to practice better RHH but they tended not to follow this advice

3. Awareness and attitudes to the vaccination 

  • There was good knowledge about the vaccination due to media coverage and communication via GPs
  • There was high claimed take-up of the vaccination amongst older respondents and those with underlying health conditions
  • However, most pregnant women claimed they did not want to have the vaccination due to concerns about safety and the perceived speed of introduction

4. Information needs 

‘In Controls’ 

Knowledge about the pandemic was high. However, there was a desire for specific information about:

  • The ongoing risks to the public and a desire for ‘facts and figures’
  • The safety of the antiviral and vaccination, especially for pregnant women
  • RHH, specifically in relation to swine flu to reduce the risk from others


Getting more information about RHH and the link with swine flu was considered useful. This was in relation to:

  • The risks of poor RHH in the home
  • Specific messages around germs in the home and from visitors
  • Good RHH for adults as well as children

‘Disconnected Passives’ 

Information needs identified centred on:  

  • Communicating a direct link between RHH, the spread of germs and swine flu
  • Reinforcing RHH messages in the home and the importance of good RHH for adults and children
  • Communicating the need for ‘quarantining’ to avoid spreading the virus between families

‘Disconnected Cynics’ 

As there was little expressed interest in receiving more information about the pandemic, no real needs were presented

5. Responses to swine flu communications 

  • There was some recall of the current communications, particularly the ‘Catch it, bin it, kill it’ advert and the adverts on RHH/the spread of germs
  • Both were relatively well received although they generated some confusion amongst those with limited English
  • Other communications (Swine flu vaccination advert, Flu Friends information leaflets and the antiviral collection points poster) shown were more problematic given lack of English and mother tongue literacy

Research objectives


A number of specific research objectives had been identified to uncover:

  • General attitudes to health and the NHS
  • Current attitudes, perceptions and behaviours with respect to respiratory and hand hygiene (RHH) and any impact on RHH behaviour in the light of current swine flu communications
  • Levels of awareness, knowledge and attitudes regarding the current pandemic flu and understanding of the differences with seasonal flu
  • Awareness of those who are most at risk of contracting pandemic flu, as well as where and how to access information and treatment if contracted
  • Perceptions of how well prepared the Government is and where responsibilities, including personal, are seen to lie in dealing with the pandemic
  • Awareness, knowledge and attitudes to seasonal and pandemic flu vaccinations, including likely take-up of the swine flu vaccination
  • Understanding of vaccinations versus antivirals, including issues around perceptions of the key priority groups for the vaccinations, how these are to be delivered and information needs around vaccinations
  • Responses to and impact of the current swine flu communications on the attitudes and behaviours of individuals from BME communities
  • Communication needs amongst the BME communities and relevant sources of information and media



A need for research amongst people from black and ethnic minority (BME) communities was identified by the Department of Health (DH) to understand the factors surrounding BME communities and swine flu. The study was required to identify the relevance and effectiveness of the DH's swine flu communications and the specific communication needs amongst the BME communities.

In order to identify this, a range of communications materials, some in English only and others translated into mother tongue languages, were shown to participants at Stage 2:

  • A swine flu vaccination/syringe advert (English)
  • Three respiratory and hand hygiene/germs press adverts (English)
  • An antiviral collection point leaflet (English and Bengali, Cantonese, Hindi, Urdu, Gujerati), created by NHS Nottinghamshire County
  • The ‘Catch it, bin it, kill It’ advert (English)
  • The Flu Friend form (Urdu, Bengali, Mandarin), created by NHS Oxfordshire
  • Flu Friends information (Urdu, Bengali, Mandarin, English), created by NHS Oxfordshire.


Quick summary


The Department of Health has been undertaking a weekly tracker of public perceptions and attitudes to the swine flu pandemic in 2009. During August 2009, the tracker highlighted that ethnic minority individuals were notably more concerned than average about the pandemic and research was undertaken to understand the factors that could lie behind these differences in perceptions and attitudes.

Audience Summary









  • 25 to 65 years
  • Over 65 years


Social Class






The research was conducted in two phases amongst two sample strands.

Sample strand 1

  • A scoping phase was undertaken amongst health professionals who had direct contact with a number of ethnic minority communities
  • These included GPs, practice nurses, health visitors and pharmacists in areas of high ethnic populations
  • The purpose was to ascertain, from their experience, the nature of concern about pandemic flu amongst their patients and clients and to provide insights into their behaviour in relation to swine flu
  • This phase was also intended to help inform the sample composition for the second phase of research

Sample strand 2

  • The second phase of research was undertaken amongst people from seven BME communities where concern about swine flu was deemed to be high
  • The sample included people from the Indian, Bangladeshi, Pakistani, Black Caribbean, Black African, Somali and Chinese communities
  • This stage included: parents aged between 25 and 45 years old with a spread of children’s ages represented across this sample, which also included some pregnant women amongst the female sample across the seven BME groups; people aged between 46 and 65 years old, half of whom had underlying medical conditions (chronic respiratory disease, asthma, heart disease, chronic renal disease, chronic liver disease, stroke, diabetes or problems with immune systems); people aged over 65, accompanied by their family member or friend who assisted them with accessing health services due to their lack of English language comprehension or skill
  • All those participating in the research had recorded concern about swine flu at recruitment
  • Additionally, the overall sample was designed to include those defined as part of the priority group for the swine flu vaccination and people considered at higher risk of contracting swine flu (i.e. pregnant women and those with underlying health problems specified above) 
  • Also included were people living in extended family situations, i.e. families with three generations living in the same household, as part of the Indian, Bangladeshi and Pakistani samples
  • The overall sample included a mix of language skills from those with good levels of English language skill to those more confident in communicating in their mother tongue language

Data collection methodology

Depth interviews
Focus groups

Sample size

  • 11 groups
  • 26 paired depths

Fieldwork dates


October to November 2009

Agree to publish



Research agency

Ethnic Dimension

COI Number