Who Will Get Tested in the Next Pandemic?

Self-interest held sway over public health benefit, as did autonomy and freedom of choice over mandates, as determinants of willingness to be tested for pathogen exposure, in interviews of a focus group encountering a hypothetical avian influenza outbreak.¹

"To adequately prepare for future potential hazards like human-to-human avian influenza, there is a necessity of targeted research to identify determinants of testing behavior in an early phase of such an outbreak," statde lead author Rosa van Hoorn, MSc, Infectious disease department, Public Health Service Haaglanden, The Hague, the Netherlands, and colleagues.

"These insights help improve future testing strategies and shape communication campaigns to stimulate testing, so that testing can effectively be used by public health institutions to mitigate public health risks of an outbreak," the investigators explain.

van Hoorn and colleagues recruited 17 participants (median age 44 years [range 20-81], 71% women) with diverse backgrounds to be interviewed about their general willingness to be tested during an infectious disease outbreak. Twenty-two other persons who registered to participate subsequently withdrew, or were excluded as the sample comprised participants with similar demographics.

Semi-structured, individual interviews were based on the Theoretical Domains Framework, consisting of 14 theory-based domains of determinants of behavior change, including cognitive, affective, social and environmental influences.After initial questions to assess knowledge and general opinions of avian influenza and testing, each participant was shown a short animation depicting a hypothetical outbreak.

The presentation described an outbreak in poultry and increasing reports of symptoms in humans, unconfirmed indications of human-to-human transmission, and public health advisories to follow preventive measures and obtain testing.It then depicted a growing outbreak with confirmed human-to-human transmission in absence of an available vaccine, and increasing hospital admissions across all ages. Public health advisories to follow preventive measures and obtain testing become more adamant.

"It should be noted that the animation refers to infections in the general population, without explicitly stating that the respondent will be affected," van Hoorn and colleagues indicate."The overall purpose of the different steps is to imitate the development of a real emerging outbreak so that responses are not contingent on one specific phase."

The investigators found that freedom to decide on testing was key to it being acceptable, while a decreased sense of autonomy would reduce willingness to be tested.They also found that benefits to the individual and protection for those close to them were more likely to prompt cooperation with testing programs than population-level benefits. The perception and expectations of disease severity was also a strong factor in willingness to be tested.

"Participants reported that they would test when experiencing symptoms, either immediately or after postponing in case of very mild symptoms.Some participants with a lower willingness to test stated that they would only test when they perceived the symptoms as severe or unusual," van Hoorn and colleagues related.

The investigators noted that previous experiences from the COVID-19 pandemic influenced their responses about testing in the hypothetical avian influenza outbreak.

External conditions like being unable to go to work were likely to prompt testing; while lower trust in government authorities corresponded to less willingness to be tested.

van Hoorn and colleagues suggest public health programs that promote testing should balance people's need for autonomy with being directed.In addition to conveying the dangers of the contagion and guidance to mitigate exposure and transmission, they encourage a focus on "rebuilding trust in institutions and acknowledging how prior experiences with testing may shape testing behavior in future outbreaks."

Reference

1.van Hoorn RC, van Gestel LC, Griffioen DS, et al. Behavioural determinants of testing behaviour during a hypothetical avian influenza outbreak: An interview study. medRxiv 2026, preprint posted March 19. doi:https://doi.org/10.64898/2026.03.17.26348610.