Table 4 Factors that can influence uptake of vaccine for pandemic influenza identified in the study using COM-B

The capacity to engage in the behaviour

Brain processes that energise and direct behaviour

Factors lying outside the individual that act as barriers or promoters of behaviour

Psychological

Automatic

Physical

Capacity to engage in necessary thought processes

Emotions and impulses

Physical opportunity in the environment

Knowledge of the disease

Emotion: Fear

Access

• Pandemic influenza is a novel strain

• Expressed not just numerically but in terms of physical and emotional proximity

• to treatments

• Awareness of morbidity, mortality and transmission rates

• to professional advice

Memory

Habitual behaviour

Able to book to see GP

• Media exaggeration of last pandemic

• Being vaccinated for seasonal influenza and taking medicines in general

Avoiding ‘hubs of infection’

Physical

Reflective

Social

Capacity to engage in necessary physical processes

Evaluation and plans

Cultural milieu that affects what we think about things

• Not salient/not mentioned

Beliefs about consequences

Social influences

• Pandemic influenza is not more serious than seasonal influenza

• Respected others are being vaccinated

• The vaccine has not been adequately tested and may be unsafe or ineffective

• Believing that it is unacceptable to put others at risk

Omission bias

Trust

• Believing that the risks of being vaccinated outweigh the risk of being ill with pandemic influenza

• Recommendation from trusted health professional

• Respected others recommend

Identity (health)

Group identity

• Believing that a healthy lifestyle confers immunity

• Being part of an at-risk support group

Optimistic bias

• Tending to the view that they will not be infected or will make an easy recovery from pandemic influenza

Social role

• Responsibility for other family members, including unborn

Anticipated regret

• Concern that the outbreak could be more serious than expected and have not been vaccinated