Behavioural determinants of testing behaviour during a hypothetical avian influenza outbreak: an interview study

Behavioural determinants of testing behaviour during a hypothetical avian influenza outbreak: an interview study | medRxiv Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Behavioural determinants of testing behaviour during a hypothetical avian influenza outbreak: an interview study View ORCID Profile Rosa C. van Hoorn , View ORCID Profile Laurens C. van Gestel , Diana S. Griffioen , View ORCID Profile Mariska W.F. Petrignani , Coco Kersten , Margriet Müskens , Laura Vols , View ORCID Profile Hanneke Borgdorff , View ORCID Profile Irene M. van der Meer , View ORCID Profile Marieke A. Adriaanse , View ORCID Profile Adriënne S. van der Schoor doi: https://doi.org/10.64898/2026.03.17.26348610 Rosa C. van Hoorn 1 Infectious disease department, Public Health Service Haaglanden , The Hague, the Netherlands 2 Health, medical and neuropsychology unit, Leiden University , Leiden, the Netherlands 4 Infectious disease control, Academic Collaborative Centre for Public Health Lumens, The Hague and Leiden , the Netherlands Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Rosa C. van Hoorn For correspondence: rosa.vanhoorn{at}ggdhaaglanden.nl Laurens C. van Gestel 2 Health, medical and neuropsychology unit, Leiden University , Leiden, the Netherlands 3 Department of Public Health and Primary Care Campus The Hague, Leiden University Medical Centre , Leiden, the Netherlands 4 Infectious disease control, Academic Collaborative Centre for Public Health Lumens, The Hague and Leiden , the Netherlands Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Laurens C. van Gestel Diana S. Griffioen 1 Infectious disease department, Public Health Service Haaglanden , The Hague, the Netherlands Find this author on Google Scholar Find this author on PubMed Search for this author on this site Mariska W.F. Petrignani 1 Infectious disease department, Public Health Service Haaglanden , The Hague, the Netherlands 4 Infectious disease control, Academic Collaborative Centre for Public Health Lumens, The Hague and Leiden , the Netherlands Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Mariska W.F. Petrignani Coco Kersten 1 Infectious disease department, Public Health Service Haaglanden , The Hague, the Netherlands Find this author on Google Scholar Find this author on PubMed Search for this author on this site Margriet Müskens 1 Infectious disease department, Public Health Service Haaglanden , The Hague, the Netherlands Find this author on Google Scholar Find this author on PubMed Search for this author on this site Laura Vols 1 Infectious disease department, Public Health Service Haaglanden , The Hague, the Netherlands Find this author on Google Scholar Find this author on PubMed Search for this author on this site Hanneke Borgdorff 3 Department of Public Health and Primary Care Campus The Hague, Leiden University Medical Centre , Leiden, the Netherlands 4 Infectious disease control, Academic Collaborative Centre for Public Health Lumens, The Hague and Leiden , the Netherlands Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Hanneke Borgdorff Irene M. van der Meer 5 Epidemiology and policy advice department, Public Health Service Haaglanden , The Hague, the Netherlands Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Irene M. van der Meer Marieke A. Adriaanse 2 Health, medical and neuropsychology unit, Leiden University , Leiden, the Netherlands 3 Department of Public Health and Primary Care Campus The Hague, Leiden University Medical Centre , Leiden, the Netherlands Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Marieke A. Adriaanse Adriënne S. van der Schoor 1 Infectious disease department, Public Health Service Haaglanden , The Hague, the Netherlands 4 Infectious disease control, Academic Collaborative Centre for Public Health Lumens, The Hague and Leiden , the Netherlands Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Adriënne S. van der Schoor Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Background Avian Influenza (AI) is a potential pandemic threat, specifically when human-to-human transmission occurs. For outbreak management testing is essential. Current knowledge on testing behaviour is mostly derived from other infectious diseases such as COVID-19. It is necessary to identify determinants of testing behaviour for AI in an early phase. Therefore, this interview study aims to identify a wide range of behavioural determinants of testing during a hypothetical human-to-human transmissible AI outbreak. Methods Semi-structured in-depth interviews, based on the Theoretical Domains Framework, were carried out between May 2024 and February 2025. Participants were included through purposive and convenience sampling. During the interviews an animation was shown illustrating a hypothetical AI outbreak. Verbatim transcripts were thematically analysed. Results We included seventeen participants (median age 44, range 20-81; 71% women) with diverse backgrounds in terms of age, gender, educational level and country of birth. We found that having the freedom to decide to test would make testing more acceptable, whereas a decreased sense of autonomy would discourage testing. Most themes included individual rather than population-level benefits as drivers of testing behaviour. These included protecting loved ones, one’s own health and gaining psychological reassurance. External conditions like being unable to go to work or an event would generally encourage testing behaviour. Lower trust in governmental authorities could hamper testing behaviour. Previous experiences from the COVID-19 pandemic shaped participants’ answers about AI testing behaviour. Conclusion Key considerations include balancing people’s need for autonomy with the external measures imposed by employers or the government, rebuilding trust in institutions and acknowledging how prior experiences with testing may shape testing behaviour in future AI outbreaks. Further research is needed to determine how these findings can be translated into effective communication and how trust in authorities can be build. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study was supported by ZonMw (projectnumber 10710032310014) an organisation that stimulates innovations to improve healthcare in the Netherlands. The funder had no involvement in study design, data collection, analysis, interpretation of the findings or in manuscript preparation. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Medical Research Ethics Committee Leiden and The Hague (METC LDD) determined that this study does not meet the criteria of the Medical Research Involving Human Subjects Act and is therefore classified as non-WMO research (N24.031). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Due to the sensitive nature of the qualitative data and the potential for identification, we manage data sharing carefully. Any request for access to individual data are assessed by the research team. Abbreviations AI Avian Influenza CBS Central Statistical Office of the Netherlands COM-B Capability, Opportunity and Motivation model of Behaviour METC LDD The Medical Research Ethics Committee Leiden and The Hague RIVM National Institute for Public Health and the Environment TDF Theoretical Domains Framework. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license . Back to top Previous Next Posted March 19, 2026. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. 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Adriaanse , Adriënne S. van der Schoor medRxiv 2026.03.17.26348610; doi: https://doi.org/10.64898/2026.03.17.26348610 Share This Article: Copy Citation Tools Behavioural determinants of testing behaviour during a hypothetical avian influenza outbreak: an interview study Rosa C. van Hoorn , Laurens C. van Gestel , Diana S. Griffioen , Mariska W.F. Petrignani , Coco Kersten , Margriet Müskens , Laura Vols , Hanneke Borgdorff , Irene M. van der Meer , Marieke A. 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