Compliance without fear: Individual-level protective behaviour during the first wave of the COVID-19 pandemic

Trajectories of Compliance With COVID-19 Related Guidelines: Longitudinal Analyses of 50,000 UK Adults

BACKGROUND

Governments have implemented a range of measures focused on changing citizens' behaviors to lower the transmission of COVID-19. While international data shows that compliance did decline from the start of the pandemic, average trends could mask considerable heterogeneity in compliance behaviors.

PURPOSE

To explore trajectories of compliance with COVID-19 guidelines.

METHODS

We used longitudinal data on self-reported compliance from 50,851 adults in the COVID-19 Social Study collected across two waves of the pandemic in the UK (April 01, 2020-February 22, 2021). We modeled typical compliance trajectories using latent class growth analysis (LCGA) and used multinomial logistic regression to examine whether individual personality and demographic characteristics were related to compliance trajectories.

RESULTS

We selected a four-class LCGA solution. Most individuals maintained high levels of compliance and reported similar levels of compliance across the first and second waves. Approximately 15% of participants had decreasing levels of compliance across the pandemic, reporting noticeably lower levels of compliance in the second wave. Individuals with declining compliance levels were younger on average, in better physical health, had lower empathy and conscientiousness and greater general willingness to take risks.

CONCLUSIONS

While a minority, not all individuals have maintained high compliance across the pandemic. Decreasing compliance is related to several psychological traits. The results suggest that targeting of behavior change messages later in the pandemic may be needed to increase compliance.

Adhering to COVID-19 health guidelines: A behavioral-failure perspective

The mitigation of pandemics like that caused by the current COVID-19 virus is largely dependent on voluntary public adherence to government rules and regulations. Recent research has identified various individual covariates that account for some of the variance in compliance with COVID-19 behavioral guidelines. However, despite considerable research, our understanding of how and why these factors are related to adherence behavior is limited. Additionally, it is less clear whether disease-transmitting behaviors during a pandemic can be understood in terms of more general behavioral tendencies. The current research has examined the utility of a behavioral-failure lens in predicting adherence to COVID-19 guidelines and in illuminating mechanisms underlying the previously established relationship between Conscientiousness and adherence. In the two studies reported here, individual variations in the predisposition to behavioral failures predicted adherence to COVID-19 measures, and mediated the relationships between Conscientiousness and adherence. The Failure Proneness (FP) questionnaire predicted compliance with COVID-19 guidelines, while the Cognitive Failure Questionnaire (CFQ) did not. The results of hierarchical regressions showed that COVID-19 behavior was predicted only through the intentional factors (and mainly by Noncompliance-Violations). Hence, our data lend support to the notion that noncompliance with official COVID-19 prevention guidelines is driven mainly by intentional factors related to violation of norms and rules. The theoretical and practical implications of this finding are discussed.

Incorporating Fuzzy Cognitive Inference for Vaccine Hesitancy Measuring

Vaccine hesitancy plays a key role in vaccine delay and refusal, but its measurement is still a challenge due to multiple intricacies and uncertainties in factors. This paper attempts to tackle this problem through fuzzy cognitive inference techniques. Firstly, we formulate a vaccine hesitancy determinants matrix containing multi-level factors. Relations between factors are formulated through group decision-making of domain experts, which results in a fuzzy cognitive map. The subjective uncertainty of linguistic variables is expressed by fuzzy numbers. A double-weighted method is designed to integrate the distinguished decisions, in which the subjective hesitancy is considered for each decision. Next, three typical scenarios are constructed to identify key and sensitive factors under different experimental conditions. The experimental results are further discussed, which enrich the approaches of vaccine hesitancy estimation for the post-pandemic global recovery.

Affective States During the First Wave of the COVID-19 Pandemic: Progression of Intensity and Relation With Public Health Compliance Behavior

The COVID-19 pandemic was expected to cause intense affective reactions. This situation provided a unique opportunity to examine the characteristics and correlates of emotions in a real-world context with great significance. Our study aimed to describe the progression of positive and negative affective states during the pandemic, and to investigate which affective states predicted compliance with public health measures. We undertook a survey of affective states in the province of Quebec at the beginning, the peak, and the aftermath of the first wave of the COVID-19 pandemic. We recruited 530 responders; 154 responded to all three surveys. We used self-report scales to measure affective states and compliance with public health measures. We then computed separate linear regressions for the three phases of our study, with compliance with health measures as the dependent variable. Affective states were generally most intense at the beginning of the pandemic. Fear-related pandemic-related affective states reliably predicted compliance with public health measures in the three phases of our study. Positively valenced affective states related to the societal response also contributed predictive value, but only at the peak of the first wave.

Mental Representations of Sickness Positively Relate to Adaptive Health Behaviors

An ecological approach to social perception states that impressions of faces have functional value in that they guide adaptive behavior ensuring people's survival. For example, people may avoid others whose faces appear sick to avoid an illness representing a survival threat. We broadened the ecological approach in the current work by examining whether merely thinking about what illnesses on faces look like (i.e., how sickness on faces is represented) holds functional value in guiding behavior to ensure survival. Using an example of a real illness threat as proof of concept, we showed that people self-reported performing more adaptive health behaviors in response to COVID-19 if they had sicker representations of COVID-19 on faces (Experiment 1a). These sicker representations of COVID-19 on faces explained, in part, a positive relation between perceptions of COVID-19 as threatening and people's self-reported adaptive health behaviors. We then replicated these patterns when experimentally manipulating illness threat (Experiment 1b). We found that people expected more adaptive health behaviors and had sicker representations of illness on faces in response to illness threats that were more relative to less threatening. These findings suggest that mentally representing sickness on faces is enough to guide people's behaviors in response to illness threats.

A Qualitative Study Evaluating the Factors Affecting Families' Adherence to the First COVID-19 Lockdown in England Using the COM-B Model and TDF

The ability of families to adhere to public health guidance is critical to controlling a pandemic. We conducted qualitative interviews with 30 parents of children aged 18 and under, between 16 and 21 April 2020 when schools in England were closed due to the COVID-19 pandemic. Using the Theoretical Domains Framework, we classified the factors that influenced adherence to seven non-pharmaceutical interventions. We found 40 factors that influenced a family’s ability to adhere. Parents generally indicated they could adhere and reported how their family had changed their behaviour to comply with the guidance. Parents primarily reported they were motivated to adhere out of concern for the health consequences of COVID-19, and because the guidance was delivered by the government. However, we found that reduced access to resources (e.g., technology, transport, and outside space) and social influences that encouraged non-adherent behaviour, decreased adherence. Furthermore, we suggest that families with low psychological and physical ability may face additional challenges to adherence and need to be supported. During future school closures, public health agencies should account for these factors when developing guidance.

The role of party preferences in explaining acceptance of freedom restrictions in a pandemic context: the Italian case

As a consequence of the Covid-19 pandemic, several governments adopted disease containment measures limiting individual freedom, especially freedom of movement. Our contribution aims at studying the role played by party preferences in explaining attitudes towards those freedom limitations during the pandemic, taking into account the moderating role played by confidence in institutions and collectivist-individualistic orientations. Focussing on Italy, as the first western democracy to be hit by Covid-19 and to adopt harsh restrictive measures, we analyse data coming from the ResPOnsE COVID-19 project. Our study initially investigates whether attitudes towards freedom restrictions are associated with the dynamics of the pandemic and the institutional responses to it. Then, through multilevel regression models, we test several hypotheses about the relationship between party preferences, confidence in institutions, collectivistic orientations and public acceptance of Covid-19 containment measures limiting individual freedom. Findings show that party preferences are associated with different attitudes towards freedom restrictions to contain the pandemic, but this occurs only if people have individualistic orientations. Collectivistic orientations and confidence in institutions are positively associated with acceptance of freedom restrictions, regardless of party preferences. As regards the latter, neither a classical ideological explanation (conservative people more inclined to accept limitations to personal freedoms) nor a government-opposition explanation (supporters of government parties more inclined to accept freedom restrictions) seems to be adequate to fully account for the mechanisms behind acceptance of Covid-19 harsh containment measures. Thus, we offer an alternative ideological explanation by pointing out the ambiguous nature of contemporary right-wing populisms.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11135-022-01436-3.

Fatalism, beliefs, and behaviors during the COVID-19 pandemic

Little is known about how people's beliefs concerning the Coronavirus Disease 2019 (COVID-19) influence their behavior. To shed light on this, we conduct an online experiment ( n = 3 , 610 ) with US and UK residents. Participants are randomly allocated to a control group or to one of two treatment groups. The treatment groups are shown upper- or lower-bound expert estimates of the infectiousness of the virus. We present three main empirical findings. First, individuals dramatically overestimate the dangerousness and infectiousness of COVID-19 relative to expert opinion. Second, providing people with expert information partially corrects their beliefs about the virus. Third, the more infectious people believe that COVID-19 is, the less willing they are to take protective measures, a finding we dub the "fatalism effect". We develop a formal model that can explain the fatalism effect and discuss its implications for optimal policy during the pandemic.

The Differential Consequences of Fear, Anger, and Depression in Response to COVID-19 in South Korea

Studies on previous outbreaks of contagious diseases suggest that the impact of the emotions associated with an epidemic can be greater than that of the epidemic in terms of the number of people affected. This study explores the relationships between the three most commonly expressed emotional responses to the COVID-19 pandemic (fear, anger, and depression) and two outcome variables (compliance with the social-distancing policy and the stigmatization of those infected by COVID-19). A large online, public opinion survey was conducted in South Korea (n = 1000) between 4 and 11 June 2020, which was between the first and the second waves of COVID-19. A series of regression analyses suggest that the emotional response was accompanied by differential behavioral and perceptual consequences. Fear was consistently positively related to all indicators of compliance with social-distancing policies (the voluntary practice of social distancing, support for the “routine-life-distancing” policy, and support for stronger social-distancing policies). Anger was positively related to both stigmatization indicators (responsibility attribution and stigmatizing attitude toward people infected with COVID-19). Finally, depression showed negative relationships with support for the “routine-life-distancing” policy and for stronger social-distancing policies but a positive relationship with the voluntary practice of social distancing. By examining whether and how certain types of emotional responses are more or less related to compliance with social distancing and stigmatization, the present study provides practical implications for effective public communication during an epidemic such as COVID-19.

A Moderated Mediation Model Explaining the Relationship Between Risk-Group Membership, Threat Perception, Knowledge, and Adherence to COVID-19 Behavioral Measures

Background

COVID-19 is a threat to individual and global health, thus, reducing the disease's spread is of significant importance. However, adherence to behavioral measures against the spread of COVID-19 is not universal, even within vulnerable populations who are at higher risk of exposure to the virus or severe COVID-19 infection. Therefore, this study investigates how risk-group membership relates to adherence to COVID-19 behavioral measures, whether perceived threat of COVID-19 is a mechanism explaining this relationship, and whether knowledge about COVID-19 moderates these effects.

Methods

We conducted a web-based survey (N = 4,096) representative of the adult population in Germany with regard to gender, age (18 to 74), and province. Therein, we assessed risk group membership with two indicators (risk of exposure to COVID-19 and risk of severe COVID-19 infection), perceived COVID-19 threat with the Perceived Coronavirus Threat Questionnaire, knowledge about COVID-19 with a knowledge test; and adherence to six behavioral measures to protect against the spread of COVID-19 (e.g., keeping distance, using mouth-nose protection, and following contact restrictions). We used moderated mediation models to test whether perceived threat mediates the relationship between risk-group membership and adherence and whether knowledge about COVID-19 moderates this relationship.

Results

We found that risk group members had more perceived COVID-19 threat and that knowledge about COVID-19 increased perceived threat. Moreover, risk group membership had a positive direct effect on adherence to most behavioral measures and risk group members with less knowledge about COVID-19 violated measures more frequently. Risk-group membership also had positive indirect effects on adherence via perceived COVID-19 threat. The moderated indirect effects of threat indicate that threat led to more adherence when knowledge was low, but lost relevance as knowledge increased.

Conclusion

The results may help to evaluate disease-regulation measures and to combat the pandemic more effectively. For example, increasing COVID-19 knowledge in the general population could increase adherence to COVID-19 behavioral measures. However, policy makers should be mindful that this could also have negative mental health implications as knowledge increases perceived COVID-19 threat.

Fear, Hope, and COVID-19: Emotional Elite Rhetoric and Its Impact on the Public During the First Wave of the COVID-19 Pandemic

Research shows that emotions matter in politics, and they matter during a public health crisis. Yet, a comprehensive analysis of emotional political rhetoric during the COVID-19 crisis is still missing. Based on parties' position in the political arena (government versus populist radical parties), I expect differences in how specific emotions are employed and in how these messages actually influence the public. To test my hypotheses, I use word embeddings and neural network classifiers to measure fear and hope appeals in social media messages of political parties in four European countries. Furthermore, I rely on more than 1,400,000 public tweets of random citizens to estimate the impact of party messages. To do so, I employ vector autoregression (VAR) analysis to compare retweet volumes of political messages to emotional expressions in public tweets. Results indicate two main findings, (1) populist radical parties communicate less about the pandemic and decrease fear and increase hope appeals while COVID case numbers are rising whereas government parties exhibit the opposite pattern; (2) increased diffusion of party tweets consistently precedes change in partisans' emotional expressions the following day. The findings can carry important implications for (affective) polarization and the level of protective behavior among the population.

Moralizing the COVID-19 Pandemic: Self-Interest Predicts Moral Condemnation of Other's Compliance, Distancing, and Vaccination

The emergence of the novel coronavirus has put societies under tremendous pressure to instigate massive and rapid behavior change. Throughout history, an effective strategy to facilitate novel behaviors has been to morally condemn those who do not behave in an appropriate way. Accordingly, here, we investigate if complying with the advice of health authorities-for example, to physically distance or vaccinate-has emerged as a moralized issue during the COVID-19 pandemic. In Study 1, we rely on data (N = 94K) from quota-sampled rolling cross-sectional online surveys from eight countries (Denmark, Sweden, Germany, France, Italy, Hungary, the United Kingdom, and the United States). We find that large majorities find it justified to condemn those who do not keep a distance to others in public and around half of respondents blame ordinary citizens for the severity of the pandemic. Furthermore, we identify the most important predictors of condemnation to be behavior change and personal concern, while institutional trust and social distrust also play large but less consistent roles. Study 2 offers a registered replication of our findings on a representative sample of Britons (N = 1.5K). It shows that both moralization and condemnation of both vaccination and general compliance are best predicted by self-interested considerations.

Evidence of pandemic fatigue associated with stricter tiered COVID-19 restrictions

Despite the availability of effective vaccines against SARS-CoV-2, non-pharmaceutical interventions remain an important part of the effort to reduce viral circulation caused by emerging variants with the capability of evading vaccine-induced immunity. With the aim of striking a balance between effective mitigation and long-term sustainability, several governments worldwide have adopted systems of tiered interventions, of increasing stringency, that are calibrated according to periodic risk assessments. A key challenge remains in quantifying temporal changes in adherence to interventions, which can decrease over time due to pandemic fatigue, under such kind of multilevel strategies. Here, we examine whether there was a reduction in adherence to tiered restrictions that were imposed in Italy from November 2020 through May 2021, and in particular we assess whether temporal trends in adherence depended on the intensity of the restrictions adopted. We analyzed daily changes in movements and in residential time, combining mobility data with the restriction tier enforced in the Italian regions. Through mixed-effects regression models, we identified a general trend of reduction in adherence and an additional effect of faster waning associated with the most stringent tier. We estimated both effects being of the same order of magnitude, suggesting that adherence decreased twice as fast during the strictest tier as in the least stringent one. Our results provide a quantitative measure of behavioral responses to tiered interventions-a metric of pandemic fatigue-that can be integrated into mathematical models to evaluate future epidemic scenarios.

Transit use reduction following COVID-19: The effect of threat appraisal, proactive coping and institutional trust

Transit systems suffered from a significant demand decrease during COVID-19. Understanding the psychological motivators underlying reduced transit use can help transit authorities and operators to take proactive action towards returning to the "new normal" and increasing their preparedness towards future pandemics. This study is based on the protection motivation theory to understand the effect of threat appraisal, and coping appraisal and denial mechanisms on transit use reduction for commuting. The behavioral framework is validated by a survey of 856 transit users in Israel during August 2020, three months after the end of the lockdown and before the vaccine administration. The results show that: i) Skepticism, risk ubiquity, and personal immunity beliefs lead to maladaptive threat appraisal; ii) wearing masks and social distancing are antecedents of fear of infection while using transit and reduced transit use; iii) higher perceived threat deters transit use, while trust in transit operators motivates transit use; and iv) in a franchised transit system, trust in transit operators depends on the perceived level-of-service and trust in the ability of government authorities to regulate, monitor and enforce transit operators' preventive and protective actions.

Motivated Helplessness in the Coronavirus Pandemic: Experimental Evidence that Perceived Helplessness to Avoid the Virus Reduces Fear of Covid-19

Introduction: According to the motivated helplessness hypothesis, thinking that there is nothing to do to avoid the coronavirus may make people less afraid of being infected (Lifshin et al., 2020). Previous correlational evidence indicated that high levels of helplessness were associated with diminished fear of COVID-19 (Lifshin et al., 2020; Lifshin & Mikulincer, 2021). Method: We tested if manipulated perceived helplessness to avoid the virus using bogus messages (high, low or moderate helplessness) would reduce fear of COVID-19, state anxiety, and motivation for protective actions. Results: Supporting the hypothesis, in the high helplessness condition, higher perceived helplessness related to less fear of COVID-19, but this did not occur in the low and moderate helplessness control conditions. Perceived helplessness in the helplessness condition also indirectly reduced state anxiety and motivation for protective actions. Discussion: This research may advance the psychological study of helplessness and our understanding of human behavior during the COVID-19 pandemic.

How do perceptions of public health measures affect experience of unmet healthcare needs among older Korean adults during COVID-19 pandemic?

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Lack of or inadequate access to needed care may deteriorate health.

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COVID-19 outbreak may prohibit access to needed care.

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A poor understanding of public health measures increased unmet healthcare needs.

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Trust and satisfaction of public health measures were not related to unmet healthcare needs.

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The findings suggest the importance of effective risk communication.

Increasing difficulties in the use of healthcare services after the COVID-19 outbreak is a major concern as ensuring access to healthcare services is a primary health policy goal. The aim of this study was to examine the impacts of public perceptions regarding COVID-19 related public health measures on older adults’ experience of unmet healthcare needs in Korea. A total of 1961 participants from the Korea Health Care System Performance, over the age of 65, were included in the analyses. Three different logistic regression models were used to assess the impact of public perceptions – understanding, trust and satisfaction- regarding COVID-19 public health measures on unmet healthcare needs. Our results show that a poor understanding of public health measures was associated with higher odds of unmet healthcare needs among Korean older adults (OR:2.65, 95%CI: 1.79–3.94). However, trust and satisfaction of public health measures were not related to unmet healthcare needs. Our findings suggest that the importance of effective risk communication to facilitate better understand quarantine polices rather than emphasizing trust or satisfaction over public health measure.

Social Norms and Preventive Behaviors in Japan and Germany During the COVID-19 Pandemic

Background

According to a recent paper by Gelfand et al., COVID-19 infection and case mortality rates are closely connected to the strength of social norms: “Tighter” cultures that abide by strict social norms are more successful in combating the pandemic than “looser” cultures that are more permissive. However, countries with similar levels of cultural tightness exhibit big differences in mortality rates. We are investigating potential explanations for this fact. Using data from Germany and Japan—two “tight” countries with very different infection and mortality rates—we examined how differences in socio-demographic and other determinants explain differences in individual preventive attitudes and behaviors.

Methods

We compared preventive attitudes and behaviors in 2020 based on real-time representative survey data and used logit regression models to study how individual attitudes and behaviors are shaped by four sets of covariates: individual socio-demographics, health, personality, and regional-level controls. Employing Blinder-Oaxaca regression techniques, we quantified the extent to which differences in averages of the covariates between Japan and Germany explain the differences in the observed preventive attitudes and behaviors.

Results

In Germany and Japan, similar proportions of the population supported mandatory vaccination, avoided travel, and avoided people with symptoms of a cold. In Germany, however, a significantly higher proportion washed their hands frequently and avoided crowds, physical contact, public transport, peak-hour shopping, and contact with the elderly. In Japan, a significantly higher proportion were willing to be vaccinated. We also show that attitudes and behaviors varied significantly more with covariates in Germany than in Japan. Differences in averages of the covariates contribute little to explaining the observed differences in preventive attitudes and behaviors between the two countries.

Conclusion

Consistent with tightness-looseness theory, the populations of Japan and Germany responded similarly to the pandemic. The observed differences in infection and fatality rates therefore cannot be explained by differences in behavior. The major difference in attitudes is the willingness to be vaccinated, which was much higher in Japan. Furthermore, the Japanese population behaved more uniformly across social groups than the German population. This difference in the degree of homogeneity has important implications for the effectiveness of policy measures during the pandemic.

Lessons learned about willingness to adopt various protective measures during the early COVID-19 pandemic in three countries

BACKGROUND

Regarding the COVID-19 pandemic, concerted efforts have been invested in research to investigate and communicate the importance of complying with protective behaviors, such as handwashing and mask wearing. Protective measures vary in how effective they are in protecting the individual against infection, how much experience people have with them, whether they provide individual or societal protection, and how they are perceived on these dimensions.

METHODS

This study assessed the willingness to follow recommended measures, depending on these features, among participants from Germany (n = 333), Hong Kong (n = 367), and the U.S. (n = 495). From April 24th to May 1st, 2020, individuals completed an online survey that assessed the antecedents of interest.

RESULTS

It was shown that assumed effectiveness, previous experience, and intended self- and other-protection positively predicted willingness to comply across countries. When measures were mainly perceived as protecting others (vs. the self), individuals were less prone to adopt them. When a measure's effectiveness to protect the individual was perceived as lower, willingness to adopt the measure increased with higher levels of prior experience and collectivism. Moreover, protecting others was more strongly related to adoption when individuals had higher levels of collectivism and lower levels of individualism.

CONCLUSIONS

Emphasizing the benefit for others could be a means to lower the potential detrimental effects of low assumed effectiveness for individual protection.

"We want to live a little longer and our family want[s] us around": A summative content analysis of adherence to COVID-19-related guidelines using the Theoretical Domains Framework

Objective

Public adherence to COVID‐19‐related government guidance varied during the initial lockdown in the UK, but the determinants of public adherence to such guidance are unclear. We capture spontaneous reflections on adherence to UK government guidance from a representative UK sample, and use the TDF to identify key determinants of COVID‐related behaviours.

Design

The design was cross‐sectional.

Methods

Qualitative data were collected from a large sample of UK adults (N = 2,252) via an online questionnaire as part of a wider survey about the UK public’s responses to the government’s COVID‐19‐related guidance. Summative content analysis was used to identify key guideline terms in the data, followed by latent analysis to interpret the underlying meanings behind the terms using the TDF as an analytical framework.

Results

Six TDF domains were identified in the data: Environmental Context and Resources; Beliefs about Consequences; Social Influences; Memory, Attention and Decision Processes; Emotion; and Knowledge. Although the samples were motivated and capable of adhering, limitations in their environments, resources, and social support mechanisms restricted behaviour. Self‐reported adherence was sensitive to positive and negative beliefs about the effectiveness of the measures, in addition to interpretations of the terms ‘essential’ and ‘necessary’ in the guidance.

Conclusions

Despite extensive structural obstacles to adherence, the majority of the British public were able to follow government COVID‐19‐related instructions, provided they had sufficient resources, social support, and positive perceptions about the effectiveness of the measures. Ambiguities surrounding key terminology in the guidance left room for interpretation, which may have contributed to non‐adherence.

Willingness to Take the Booster Vaccine in a Nationally Representative Sample of Danes

We estimate the willingness to take the booster dose in a representative sample of Danes. We estimate an overall willingness in the adult Danish population of about 87 percent and a willingness of about 95.5 percent among primary vaccine takers. Moreover, we show that these percentages are significantly lower among younger populations, as well as among groups who do not see COVID-19 as a threat to society, those who do not feel that they have the ability to follow recommendations (‘self-efficacy’), those who do not perceive the advice of the health authorities as effective against disease spread (‘response efficacy’), and those who feel that the costs of following recommendations are high (‘response cost’).

An application of the extended parallel process model to protective behaviors against COVID-19 in South Korea

This study applied the extended parallel process model (EPPM) to investigate the factors affecting people's preventive behaviors against COVID-19, and thereby, draw relevant policy implications for current and future other epidemics. The EPPM was used to examine the danger control and fear control responses, along with the separate effects of their sub-factors (perceived susceptibility, perceived severity, response efficacy, and self-efficacy) on personal hygiene behaviors, social distancing measures, and fatalism. In total, data from an online survey of 813 adults were analyzed. The results of multiple regression analysis showed a strong effect of self-efficacy on danger control (ß = 0.23 for personal hygiene behaviors, β = 0.26 for social distancing) and fear control responses (ß = -0.13 for fatalism). However, based on the type of control response, the effect of perceived susceptibility and perceived severity, which were the main factors in threat appraisal, was insignificant or marginally significant. Further, a higher perceived severity was associated with higher fatalism in the fear control response (ß = 0.09). Those who were currently employed performed fewer social distancing measures compared to those who did not (ß = -0.11), whereas there was no difference in personal hygiene behaviors. These results suggest that risk communication in emerging infectious disease crises should provide customized information on people who are hard to comply with social distancing. Besides delivering the message of self-efficacy, policies should be implemented to create a social environment in which individuals can practice social distancing without constraints.

Preterm birth, stillbirth and early neonatal mortality during the Danish COVID-19 lockdown

Using provisional or opportunistic data, three nationwide studies (The Netherlands, the USA and Denmark) have identified a reduction in preterm or extremely preterm births during periods of COVID-19 restrictions. However, none of the studies accounted for perinatal deaths. To determine whether the reduction in extremely preterm births, observed in Denmark during the COVID-19 lockdown, could be the result of an increase in perinatal deaths and to assess the impact of extended COVID-19 restrictions, we performed a nationwide Danish register-based prevalence proportion study. We examined all singleton pregnancies delivered in Denmark during the COVID-19 strict lockdown calendar periods (March 12-April 14, 2015-2020, N = 31,164 births) and the extended calendar periods of COVID-19 restrictions (February 27-September 30, 2015-2020, N = 214,862 births). The extremely preterm birth rate was reduced (OR 0.27, 95% CI 0.07 to 0.86) during the strict lockdown period in 2020, while perinatal mortality was not significantly different. During the extended period of restrictions in 2020, the extremely preterm birth rate was marginally reduced, and a significant reduction in the stillbirth rate (OR 0.69, 0.50 to 0.95) was observed. No changes in early neonatal mortality rates were found.Conclusion: Stillbirth and extremely preterm birth rates were reduced in Denmark during the period of COVID-19 restrictions and lockdown, respectively, suggesting that aspects of these containment and control measures confer an element of protection. The present observational study does not allow for causal inference; however, the results support the design of studies to ascertain whether behavioural or social changes for pregnant women may improve pregnancy outcomes. What is Known: • The aetiologies of preterm birth and stillbirth are multifaceted and linked to a wide range of socio-demographic, medical, obstetric, foetal, psychosocial and environmental factors. • The COVID-19 lockdown saw a reduction in extremely preterm births in Denmark and other high-income countries. An urgent question is whether this reduction can be explained by increased perinatal mortality. What is New: • The reduction in extremely preterm births during the Danish COVID-19 lockdown was not a consequence of increased perinatal mortality, which remained unchanged during this period. • The stillbirth rate was reduced throughout the extended period of COVID-19 restrictions.

Citizen Compliance with Pandemic Rules in China: Exploring the Effects of Emotional States, Peer Influence, and Policing

In December 2019, the SARS-CoV-2 virus was first detected in Wuhan, China. Soon after, China became the first country in the world to enforce strict restrictions in an effort to mitigate the spread of the disease. Relying on survey data from 600 Chinese citizens in urban China, this study assessed the extent of citizen compliance and factors related to public compliance to pandemic lockdown and mitigation rules during the initial peak of the pandemic in January, 2020. Using multivariate regressions, we explored the effects of three sets of factors on Chinese citizens’ compliance to pandemic mitigation rules: negative emotions during the pandemic, peer modeling of compliance, and the prevalence of formal social control in the forms of police presence and performance. Our regression analyses suggest that all three mechanisms influence Chinese citizens’ level of compliance with counter-pandemic rules. Nevertheless, the strengths of their effects varied, with peer influence showing the strongest effect on compliance, followed by police presence and fear of contracting COVID-19.

Communicate hope to motivate the public during the COVID-19 pandemic

How should health authorities communicate to motivate the public to comply with health advice during a prolonged health crisis such as a pandemic? During the SARS-CoV-2 pandemic, for example, people have had to comply with successive restrictions as the world faced multiple races between controlling new waves of the virus and the development and implementation of vaccines. Here, we examine how health authorities and governments most effectively motivate the public by focusing on a specific race: between the Alpha variant and the implementation of the first generation of COVID-19 vaccinations in the winter of 2021. Following prior research on crisis communication, we focus on appeals to fear and hope using communicative aids in the form of visualizations based on epidemiological modelling. Using a population-based experiment conducted in United States ([Formula: see text]), we demonstrate that a hope-oriented visual communication aid, depicting the competing effects on the epidemic curve of (1) a more infectious variant and (2) vaccinations, motivates public action more effectively than a fear-oriented visual communication, focusing exclusively on the threat of the new variant. The importance of the implementation of such hope-oriented messages is further highlighted by cross-national representative surveys from eight countries ([Formula: see text]), which demonstrate that feelings of fear towards the Alpha variant alone were insufficient to activate strong compliance. Overall, these findings provide general insights into the importance of hope as a health communication strategy during the COVID-19 pandemic and beyond.

Using behavioural theory to understand adherence to behaviours that reduce transmission of COVID-19; evidence from the CHARIS representative national study

OBJECTIVES

To examine the ability of four models of behaviour, namely, Protection Motivation Theory (PMT), the Common Sense Self-Regulation Model (CS-SRM), and Social Cognitive Theory and the Reasoned Action Approach (SCT and RAA) to understand adherence to transmission-reducing behaviours (TRBs) advised by national governments for suppression of SARS-CoV2.

DESIGN

A series of six cross-sectional telephone surveys of a random representative sample of adults living in Scotland.

METHODS

Self-reported adherence to three TRBs (physical distancing, wearing a face covering and handwashing), PMT, CS-SRM, and SCT/RAA constructs, and sociodemographic variables were measured each week for 6 weeks (n = ~500 p/w; third June-15th July) via a 15 min telephone survey.

RESULTS

Adherence was high ('Always' or 'Most times') throughout for physical distancing and handwashing, and, when mandated, for wearing a face covering. Older people were more adherent to all TRBs. Constructs from all three models predicted all three TRBs. Intention and self-efficacy (SCT/RAA) were the only beliefs to predict to all three TRBs each week and for all groups equally; intention was the strongest predictor. The predictive utility of PMT and CS-SRM varied by TRB and by group. Of note was the observation that several illness beliefs were associated with adherence only for those who believed they had not had COVID-19.

CONCLUSIONS

The CHARIS project has identified beliefs about specific behaviours, the illness and the risks associated with lower adherence rates that might be addressed in national interventions. It confirms previous findings that some groups show lower levels of adherence and might be specially targeted.

Worry and behaviour at the start of the COVID-19 outbreak: Results from three UK surveys (the COVID-19 rapid survey of Adherence to Interventions and responses [CORSAIR] study)

We aimed to describe worry and uptake of behaviours that prevent the spread of infection (respiratory and hand hygiene, distancing) in the UK at the start of the COVID-19 outbreak (January and February 2020) and to investigate factors associated with worry and adopting protective behaviours. Three cross-sectional online surveys of UK adults (28 to 30 January, n = 2016; 3 to 6 February, n = 2002; 10 to 13 February 2020, n = 2006) were conducted. We used logistic regressions to investigate associations between outcome measures (worry, respiratory and hand hygiene behaviour, distancing behaviour) and explanatory variables. 19.8% of participants (95% CI 18.8% to 20.8%) were very or extremely worried about COVID-19. People from minoritized ethnic groups were particularly likely to feel worried. 39.9% of participants (95% CI 37.7% to 42.0%) had completed one or more hand or respiratory hygiene behaviour more than usual in the last seven days. Uptake was associated with greater worry, perceived effectiveness of individual behaviours, self-efficacy for engaging in them, and having heard more information about COVID-19. 13.7% (95% CI 12.2% to 15.2%) had reduced the number of people they had met. This was associated with greater worry, perceived effectiveness, and self-efficacy. At the start of novel infectious disease outbreaks, communications should emphasise perceived effectiveness of behaviours and the ease with which they can be carried out.

COmpliance with pandemic COmmands Scale (COCOS): The relationship between compliance with COVID-19 measures and sociodemographic and attitudinal variables

Several studies in different countries have reported that part of the population does not fully comply with the measures recommended to prevent COVID-19, and therefore poses a risk to public health. For this reason, several measures have been developed to assess the level of compliance, although many of them have methodological limitations or do not include a comprehensive set of items. The main goal of the current study was to develop a new instrument with suitable psychometric properties, which includes a more complete set of items and controls the impact of acquiescence bias. The participants were 1410 individuals (59.2% women) from Spain, who answered the new questionnaire and several items on sociodemographic and attitudinal issues. Exploratory and confirmatory factor analyses were carried out, and the results suggested that only one content factor was underlying the data. This solution was replicated in a different subsample, which shows the stability of the solution. Furthermore, the relationships between the scores of the new questionnaire and the sociodemographic and attitudinal variables are similar to those obtained in previous studies, which can be regarded as evidence of the validity of the new questionnaire.

Fear of COVID-19, compliance with recommendations against virus transmission, and attitudes towards vaccination in Sweden

Following the immense impact of the COVID-19 pandemic on health and everyday lives world-wide, people's fear of COVID-19 has been studied in a number of settings using the Fear of COVID scale. In Sweden, virus-preventing strategies have differed from comparable countries, with low use of formal lock-down procedures. It is crucial to study correlates of non-compliance with COVID-19 recommendations, and unwillingness to become vaccinated. This study aims to study whether fear of COVID is associated with mental distress and attitudes towards the pandemic, and to study correlates of non-compliance with key anti-COVID recommendations and with reluctancy to vaccination. This anonymous online survey study in web panel participants (N = 1,501) aimed to study a range of behavioral changes during COVID-19. Recommendations and vaccinations reluctancy were analyzed in logistic regressions against socio-demographic data, COVID-19 status, and mental health history. Internal consistency of the Fear of COVID scale was calculated. The Fear of COVID scale had a satisfactory internal consistency (Cronbach-alpha 0.84), and was significantly associated with compliance with all COVID-19 recommendations and with mental health. Non-compliance with recommendations was associated with low fear of disease and younger age, among other variables. Being against vaccination was associated, among other variables, with low fear of disease and with low education. In conclusion, the Fear of COVID scale appears to be associated with key attitudes towards the COVID-19 disease. Anti-virus strategies may need to promote compliance with recommendations in subgroups who feel low fear of disease or who believe not to be in a risk group for severe disease.

Peers for the fearless: Social norms facilitate preventive behaviour when individuals perceive low COVID-19 health risks

A strategy frequently adopted to contain the COVID-19 pandemic involves three non-pharmaceutical interventions that depend on high levels of compliance in society: maintaining physical distance from others, minimizing social contacts, and wearing a face mask. These measures require substantial changes in established practices of social interaction, raising the question of which factors motivate individuals to comply with these preventive behaviours. Using Austrian panel survey data from April 2020 to April 2021, we show that perceived health risks, social norms, and trust in political institutions stimulate people to engage in preventive behaviour. A moderation analysis shows that the effectiveness of social norms in facilitating preventive behaviour increases when people's perceptions of health risks decrease. No such moderation effect is observed for trust in political institutions. These results suggest that strong social norms play a crucial role in achieving high rates of preventive behaviour, especially when perceived levels of health risks are low.

Learning from the COVID-19 pandemic to combat climate change: comparing drivers of individual action in global crises

The COVID-19 pandemic and climate change are two global crises that require collective action. Yet, the inertia typically associated with behavior change to limit climate change stands in contrast to the speed associated with behavior change to stop the spread of COVID-19. Identifying the roots of these differences can help us stimulate climate-friendly behaviors. We assessed the extent to which a number of theory-based drivers underlie behaviors aiming to counter COVID-19 and climate change with an online survey (N = 534). We focused on the role of a number of drivers derived from prominent behavior change theories and meta-analyses in the field, namely, personal threat, threat to close others, threat to vulnerable others, fear, participative efficacy, injunctive and descriptive social norms, and governmental policy perceptions. We investigated (1) what drivers people perceived as most important to engage in behaviors that limit the spread of the COVID-19 pandemic and climate change and (2) the strength of the associations between these drivers and engaging in behaviors that limit the spread of the pandemic and climate change. Results highlight three key drivers for climate change action: changing perceptions of governmental policy and perceptions of threat to close others and priming participative efficacy beliefs.

Do predictors of adherence to pandemic guidelines change over time? A panel study of 22,000 UK adults during the COVID-19 pandemic

In the absence of a vaccine, governments have focused on behaviour change (e.g. social distancing and enhanced hygiene procedures) to tackle the COVID-19 pandemic. Existing research on the predictors of compliance with pandemic measures has often produced discrepant results. One explanation for this may be that the determinants of compliance are context specific. Understanding whether this is the case is important for designing public health messaging and for evaluating the generalisability of existing research. We used data from the UCL COVID-19 Social Study; a large weekly panel of UK adults from first five months of lockdown in the UK (n = 22,625). We tested whether the extent to which demographic, socio-economic position, personality traits, social and pro-social motivations, and the living environment predict compliance changed across the pandemic using multilevel regression modelling. Low compliance was strongly related to younger age and also to risk attitudes, empathic concern, and high income, among other factors. The size of some of these associations was larger in later months when less stringent lockdown and household mixing measures were in place. The results showed that compliance was lower and fell faster across some groups, suggesting the importance that public health communications adopt a plurality of messages to maximize broad adherence.

Viruses, Vaccines, and COVID-19: Explaining and Improving Risky Decision-making

Risky decision-making lies at the center of the COVID-19 pandemic and will determine future viral outbreaks. Therefore, a critical evaluation of major explanations of such decision-making is of acute practical importance. We review the underlying mechanisms and predictions offered by expectancy-value and dual-process theories. We then highlight how fuzzy-trace theory builds on these approaches and provides further insight into how knowledge, emotions, values, and metacognitive inhibition influence risky decision-making through its unique mental representational architecture (i.e., parallel verbatim and gist representations of information). We discuss how social values relate to decision-making according to fuzzy-trace theory, including how categorical gist representations cue core values. Although gist often supports health-promoting behaviors such as vaccination, social distancing, and mask-wearing, why this is not always the case as with status-quo gist is explained, and suggestions are offered for how to overcome the "battle for the gist" as it plays out in social media.

Societal activities associated with SARS-CoV-2 infection: a case-control study in Denmark, November 2020

Identification of societal activities associated with SARS-CoV-2 infection may provide an evidence base for implementing preventive measures. Here, we investigated potential determinants for infection in Denmark in a situation where society was only partially open. We conducted a national matched case-control study. Cases were recent RT-PCR test-positives, while controls, individually matched on age, sex and residence, had not previously tested positive for SARS-CoV-2. Questions concerned person contact and community exposures. Telephone interviews were performed over a 7-day period in December 2020. We included 300 cases and 317 controls and determined odds ratios (ORs) and 95% confidence intervals (95% CI) by conditional logistical regression with adjustment for household size and country of origin. Contact (OR 4.9, 95% CI 2.4-10) and close contact (OR 13, 95% CI 6.7-25) with a person with a known SARS-CoV-2 infection were main determinants. Contact most often took place in the household or work place. Community determinants included events with singing (OR 2.1, 95% CI 1.1-4.1), attending fitness centres (OR 1.8, 95% CI 1.1-2.8) and consumption of alcohol in a bar (OR 10, 95% CI 1.5-65). Other community exposures appeared not to be associated with infection, these included shopping at supermarkets, travel by public transport, dining at restaurants and private social events with few participants. Overall, the restrictions in place at the time of the study appeared to be sufficient to reduce transmission of disease in the public space, which instead largely took place following direct exposures to people with known SARS-CoV-2 infections.

Factors influencing the protective behavior of individuals during COVID-19: a transnational survey

To slow the spread of infectious disease, it is crucial to understand the engagement of protective behavior among individuals. The purpose of this study was to systematically examine individuals' protective behaviors and the associated factors across countries during COVID-19. This causal-comparative study used a self-developed online survey to assess individuals' level of engagement with six protective behaviors. Analysis of variance and McNemar's test were employed for data analysis. Three hundred and eighty-four responses were analyzed. The majority of participants lived in three areas: Taiwan, Japan, and North America. Overall, the participants reported a high level of engagement in protective behaviors. However, engagement levels varied according to several demographic variables. Hand hygiene and cleaning/ventilation are two independent behaviors that differ from almost all other protective behaviors. There is a need to target the population at risk, which demonstrates low compliance. Different strategies are needed to promote specific protective behaviors.

The Role of Collectivism-Individualism in Attitudes Toward Compliance and Psychological Responses During the COVID-19 Pandemic

This study examined the role of individual differences in horizontal and vertical individualism and collectivism, trust and worries, and concerns about COVID-19 in predicting the attitudes toward compliance of health advice and psychological responses during the COVID-19 pandemic. Chinese university students (N=384, 324 female) completed measures of individualism and collectivism, trust, attitudes toward compliance, and psychological responses to the pandemic. Results showed that not only vertical collectivist orientation but also horizontal individualist orientation significantly predicted higher willingness to comply, whereas vertical individualist orientation significantly predicted lower willingness to comply. Vertical individualist and vertical collectivist orientations predicted higher psychological response in terms of distress, anxiety, and depression, while horizontal collectivistic orientation significantly predicted less psychological problems. Implications of the effect of individual-level cultural orientations on attitudes toward public health compliance and psychological well-being during global health crises are discussed.

The predictors of adaptive and maladaptive coping behavior during the COVID-19 pandemic: The Protection Motivation Theory and the Big Five personality traits

The aim of this study was to evaluate the predictive value of the constructs proposed by two influential theoretical frameworks: the Protection Motivation Theory (PMT) and the Big Five (B5) model of personality in predicting health-related coping behavior during the SARS-CoV-2 pandemic. Both adaptive (i.e., preventive) and maladaptive (i.e., avoidant behavior and wishful thinking) coping behavior was measured. The study was conducted during the first wave of the pandemic. The sample consisted of 397 persons from the general Polish population. The findings provided strong support for the PMT constructs' predictive value, especially with regard to pandemic-related adaptive behavior. The B5 personality traits accounted for a small proportion of the variability of coping behavior, especially when maladaptive behavior was the outcome. The PMT model showed incremental validity over and above demographic variables and personality traits in predicting preventive behavior, avoidant behavior, and wishful thinking; however, the patterns of relationships differ across the types of coping behavior. According to the current results, to increase adherence to preventive measures during an epidemic, all the PMT constructs should be considered while persuasive communication to the public is formulated.

The Societal Influences and Quality of Life Among Healthcare Team Members During the COVID-19 Pandemic

Background: The coronavirus infection disease 2019 (COVID-19) pandemic is likely to put healthcare professionals across the world in an unprecedented situation. Methods: A total of 683 healthcare workers were recruited in this study. Short form-12 items (SF-12), Societal Influences Survey Questionnaire (SISQ), and Disaster-Related Psychological Screening Test (DRPST) were used to survey participants. Multiple linear regression and structural equation model (SEM) were used to explore the possible factors to the societal influences and quality of life. Results: After multiple linear regression analysis, female, older, more education years, married, regular intake, and posttraumatic stress disorder (PTSD) frequency had positive association with SISQ. To physical component summary (PCS) of SF-12, chronic illness, sleep score, PTSD frequency, and social distance had negative association, and exercise habits had positive association. A mental component summary (MCS) value of SF-12, age, participate in social activities, and social information had positive association, and PTSD frequency, sleep score, social anxiety, and depression had negative association. Under SEM analysis, PTSD had positive influence on SISQ. Sleep score and MCS value had negative influences on SISQ. PTSD severity, older age, sleep score, smoking, and nursing staff had negative influences on PCS value. Young age, PTSD frequency, sleep score, and depression had negative influences on MCS value. Conclusion: Healthcare team members with severe PTSD symptoms suffered more societal influences. Relative to PTSD severity, PTSD frequency was more important to the quality of life. Members of older age who frequently participate in clubs, volunteers, or charity activities had better mental life quality.

Young adults' physical distancing behaviors during the initial months of the COVID-19 pandemic: Adherence to guidelines and associations with alcohol use behavior

Throughout the COVID-19 pandemic, the scientific and public health communities have become increasingly focused on understanding young adults' physical distancing behaviors and the role that young adults have on viral potentiation and community spread. In the present study, we surveyed a group of 560 young adults (ages 22-28) from the greater Seattle area in April 2020, during statewide "shelter-in-place" recommendations, to examine young adults' self-reported adherence to physical distancing guidelines. Self-report measures were used to identify strong adherers and poor adherers, which we then compared in terms of engagement in specific physical distancing behaviors and alcohol use behaviors pertaining to physical distancing adherence. We found that most young adults are classified as strong adherers, and that poor adherers reported more frequent violations of physical distancing guidelines including having friends over to their residence or going over to other residences. Poor adherers were also significantly more likely to engage in high-risk alcohol use behavior, such as heavy episodic drinking, compared to those young adults who were classified as strong adherers. Our results provide initial evidence that young adults who engage in high-risk drinking may be at greater risk for non-adherence to government recommended physical distancing guidelines. This deeper understanding of young adult behavior during the COVID-19 pandemic can better inform public health outreach to increase physical distancing adherence currently, as well as in preparation for future contagious health crises that may require societal-level adherence to behavioral guidelines.

Trusting Others During a Pandemic: Investigating Potential Changes in Generalized Trust and Its Relationship With Pandemic-Related Experiences and Worry

Generalized trust, the belief that most other people can be trusted, has positive consequences for health and wellbeing. An increased sense of community is often seen in times of crisis or disaster, but it is unclear whether this is the case in the COVID-19 pandemic. The objectives of the current study were to assess whether generalized trust increased in an early pandemic phase compared to pre-pandemic levels, and whether trust was lower in individuals who felt particularly threatened or burdened in the pandemic. We compared levels of generalized trust in a population-representative Norwegian sample (n = 1,041) with pre-pandemic levels from the European Social Survey (ESS). Age- and gender-adjusted expected scores were compared to observed scores, using weighted data. Secondly, we tested whether indicators of pandemic-related strain, perceived health risks, or pandemic-related worry were associated with a lower level of generalized trust. This cross-sectional study was conducted in an early opening-up phase (May, 2020). The observed levels of generalized trust in an early pandemic phase did not differ significantly from expected levels based on pre-pandemic measures. Higher trust was found among individuals who reported personal experience with the COVID-19 disease (tested positive, admitted to hospital, or lost someone to the disease). Pandemic-related worry and a high perceived health threat were both associated with a lower level of generalized trust. These results indicate that personal experiences with the COVID-19 pandemic could influence trust in others, although this link may be context-dependent. Generalized trust is considered to be an important asset in society, and promote health and well-being. As the pandemic evolves, there is a risk that we may lose, or a chance that we could gain, trust, with potential consequences for our health.

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on 12 May 2020. The protocol, as accepted by the journal, can be found at https://doi.org/10.6084/m9.figshare.c.4878591.v1.

Transparent communication about negative features of COVID-19 vaccines decreases acceptance but increases trust

During the rapid development and rolling out of vaccines against COVID-19, researchers have called for an approach of "radical transparency," in which vaccine information is transparently disclosed to the public, even if negative information can decrease vaccine uptake. Consistent with theories about the psychology of conspiracy beliefs, these calls predict that a lack of transparency may reduce trust in health authorities and may facilitate the spread of conspiracy theories, which may limit the long-term capabilities of health authorities during and after the pandemic. On the basis of preregistered experiments conducted on large, representative samples of Americans and Danes (N > 13,000), the current study contrasts the effects of vague vaccine communication with transparent communication, which discloses either positive or negative vaccine features. The evidence demonstrates that transparent negative communication may indeed harm vaccine acceptance here and now but that it increases trust in health authorities. Furthermore, the alternative of vague, reassuring communication does not increase vaccine acceptance either and leads to both lower trust and higher endorsement of conspiracy theories.

Further evidence for motivated helplessness in the context of the COVID-19 outbreak: the case of Argentina before and during the pandemic

According to the motivated helplessness hypothesis, a sense of helplessness in coping with threats in a specific domain can serve an anxiety-buffering function. The purpose of this study was to test this hypothesis in the context of the coronavirus (COVID-19) pandemic in Argentina, using data collected before and during the pandemic. Findings supported the motivated helplessness hypothesis: Whereas feelings of helplessness to avoid being infected with COVID-19 were positively related to fear of being infected with COVID-19 and state anxiety before the pandemic, these feelings were negatively related to fear of being infected (and not directly related to state anxiety) during the pandemic. These findings demonstrate the specificity of the motivated helplessness effect and further establish this effect in the context of the COVID-19 pandemic.

Factors Related to COVID-19 Preventive Behaviors: A Structural Equation Model

Background: While COVID-19 has rapidly spread around the world, and vaccines are not widely available to the general population, the World Health Organization outlines preventive behavior as the most effective way to limit the rapid spread of the virus. Preventive behavior is associated with a number of factors that both encourage and discourage prevention. Aim: The aim of this research was to study COVID-19 threat appraisal, fear of COVID-19, trust in COVID-19 information sources, COVID-19 conspiracy beliefs and the relationship of socio-demographic variables (gender, age, level of education, place of residence, and employment status) to COVID-19 preventive behavior. Methods: The data originate from a national cross-sectional online survey (N = 2,608) undertaken in July 2020. The data were analyzed using structural equation modeling. Results: COVID-19 threat appraisal, trust in COVID-19 information sources, and fear of COVID-19 are all significant predictors of COVID-19 preventive behaviors. Together they explain 26.7% of the variance of this variable. COVID-19 conspiracy beliefs significantly negatively predict COVID-19 threat appraisal (R 2 = 0.206) and trust in COVID-19 information sources (R 2 = 0.190). COVID-19 threat appraisal contributes significantly and directly to the explanation of the fear of COVID-19 (R 2 = 0.134). Directly, as well as mediated by COVID-19 conspiracy beliefs, threat appraisal predicts trust in COVID-19 information sources (R 2 = 0.190). The relationship between COVID-19 threat appraisal and COVID-19 preventive behaviors is partially mediated by fear of COVID-19 (indirect effect 28.6%) and trust in information sources (15.8%). Socio-demographic variables add very little in prediction of COVID-19 preventive behavior. Conclusions: The study results demonstrate that COVID-19 threat appraisal is the most important factor associated with COVID-19 preventive behavior. Those Latvian residents with higher COVID-19 threat appraisal, experienced higher levels of fear of COVID-19, had more trust in COVID-19 information sources, and were more actively involved in following COVID-19 preventive behaviors. COVID-19 conspiracy beliefs negatively predict COVID-19 threat appraisal and trust in COVID-19 information sources, but not the COVID-19 preventive behaviors. Socio-demographic factors do not play an important role here.

Using the health action process approach to predict facemask use and hand washing in the early stages of the COVID-19 pandemic in China

Personal hygiene including wearing facemask and washing hands are instrumental to reduce transmission of COVID-19. The present study applied the health action process approach (HAPA) to examine the process from intention to protective behaviors in the early stages of the COVID-19 pandemic. A longitudinal online survey study was conducted among 229 individuals (61.6% females; M _age = 25.37 years, SD _age = 8.34 years) living in Hubei province, China. Action self-efficacy, outcome expectancy, risk perception, intention, planning and action control regarding facemask wearing and hand washing were assessed at baseline (Time 1), and behaviors were assessed a week later (Time 2). Data were collected from 30 January to 16 February 2020. Two structural equation models were specified to test the theory-driven determinants of the facemask wearing and hand washing respectively. The results showed that action self-efficacy predicted intentions to wear facemasks and wash hands. Intention and action control predicted both behaviors at Time 2. Associations between planning and behaviors were mixed. Mediation analyses revealed that action control significantly mediated the relationship between intention and both behaviors (facemask wearing: 90% CI [0.01, 0.12]; hand washing: 95% CI [0.01, 0.21]). Planning did not mediate the relationship between intention and the two behaviors. The findings illustrate that action self-efficacy is positively associated with intention to facemask wearing and hand washing, and action control contributes to bridging intention to behaviors. Both motivational and volitional factors warrant consideration in interventions to improve adherence to facemask wearing and hand washing in COVID-19.

Prosocial behavior of wearing a mask during an epidemic: an evolutionary explanation

In the midst of the COVID-19 pandemic, with limited or no supplies of vaccines and treatments, people and policymakers seek easy to implement and cost-effective alternatives to combat the spread of infection during the pandemic. The practice of wearing a mask, which requires change in people's usual behavior, may reduce disease transmission by preventing the virus spread from infectious to susceptible individuals. Wearing a mask may result in a public good game structure, where an individual does not want to wear a mask but desires that others wear it. This study develops and analyzes a new intervention game model that combines the mathematical models of epidemiology with evolutionary game theory. This approach quantifies how people use mask-wearing and related protecting behaviors that directly benefit the wearer and bring some advantage to other people during an epidemic. At each time-step, a suspected susceptible individual decides whether to wear a facemask, or not, due to a social learning process that accounts for the risk of infection and mask cost. Numerical results reveal a diverse and rich social dilemma structure that is hidden behind this mask-wearing dilemma. Our results highlight the sociological dimension of mask-wearing policy.

Public acceptance of COVID-19 vaccines: cross-national evidence on levels and individual-level predictors using observational data

OBJECTIVES

The management of the COVID-19 pandemic hinges on the approval of safe and effective vaccines but, equally importantly, on high vaccine acceptance among people. To facilitate vaccine acceptance via effective health communication, it is key to understand levels of vaccine scepticism and the demographic, psychological and political predictors. To this end, we examine the levels and predictors of acceptance of an approved COVID-19 vaccine.

DESIGN, SETTING AND PARTICIPANTS

We examine the levels and predictors of acceptance of an approved COVID-19 vaccine in large online surveys from eight Western democracies that differ in terms of the severity of the pandemic and their response: Denmark, France, Germany, Hungary, Sweden, Italy, UK and USA (total N=18 231). Survey respondents were quota sampled to match the population margins on age, gender and geographical location for each country. The study was conducted from September 2020 to February 2021, allowing us to assess changes in acceptance and predictors as COVID-19 vaccine programmes were rolled out.

OUTCOME MEASURE

The outcome of the study is self-reported acceptance of a COVID-19 vaccine approved and recommended by health authorities.

RESULTS

The data reveal large variations in vaccine acceptance that ranges from 83% in Denmark to 47% in France and Hungary. Lack of vaccine acceptance is associated with lack of trust in authorities and scientists, conspiratorial thinking and a lack of concern about COVID-19.

CONCLUSION

Most national levels of vaccine acceptance fall below estimates of the required threshold for herd immunity. The results emphasise the long-term importance of building trust in preparations for health emergencies such as the current pandemic. For health communication, the results emphasise the importance of focusing on personal consequences of infections and debunking of myths to guide communication strategies.

Accepting Restrictions and Compliance With Recommended Preventive Behaviors for COVID-19: A Discussion Based on the Key Approaches and Current Research on Fear Appeals

COVID-19 (Coronavirus disease 2019) is a novel coronavirus which was first detected in late December 2019 in the Wuhan Province of China. This novel coronavirus, caused by a zoonotic beta-coronavirus (SARS-CoV-), is described as highly infectious. The World Health Organization (WHO) named the novel coronavirus as COVID-19 on February 11, 2020, and declared it as a "pandemic." Almost all countries have undertaken wide-scale precautions so as to prevent or limit the spread of the virus, with most having practiced some form of "lockdown" along with "social distancing," as well as dispensed recommendations for proper hand washing, avoiding touching the face, wearing facemasks, and using disposable tissues when either coughing or sneezing. Whereas it is well known that slowing the spread of this new epidemic requires the cooperation of all citizens, some people still seem to willfully disregard the rules and guidelines, and thereby ignore the health risks posed to both themselves and to others they come into contact with. People have responded differently to lockdown rules and social distancing practices. Whilst the majority follow the rules and recommendations with great care, others are more lax or simply refuse to comply. These differences might be accounted for according to a number of factors including personal, social, cultural, mental, and economic variables. Being persuaded to comply with preventive rules, especially those concerned with health-related behaviors, also bring certain other factors into play. Fear is one of those factors, and is one of the most powerful. It is well known that fear-based appeals can be effective in inculcating health behaviors, with many theories having been developed in this area. However, both the content of the message (the level of the fear it contains) and certain personal variables can determine the persuasive power of the fear appeal. It can even have an adverse effect if not properly applied. Many theories have been developed to address the persuasive effectiveness of the fear appeal (e.g., fear-drive theory, protection-motivation theory), and this study aims to discuss these individual differences in precautionary and preventive measures for the COVID-19 pandemic within the framework of the basic assumptions of these theoretical approaches.

The Moderating Role of Caregiving on Fear of COVID-19 and Post-Traumatic Stress Symptoms

Caregiving has been associated with increased levels of fear and post-traumatic stress symptoms (PTSS) during COVID-19 pandemic. However, there is a lack of studies that analyze when the relationship between fear and PTSS occur, using informal caregiving as a moderator variable. To explore this moderating role, we conducted a cross-sectional online study between November 2020 and January 2021. A total of 503 men and women from the Spanish general population completed the survey. Sociodemographic and Covid-19-related data, fear of COVID-19, PTSS symptoms, and current psychological history were assessed. Prevalence of informal caregiving in the sample was 16.5%. Increased levels of fear and PTSS were found in caregivers compared to non-caregivers. Female gender and high number of COVID-19 related risk factors was also associated with fear and PTSS severity. The moderation analyses showed an interaction effect between caregiving and fear of COVID-19 when predicting PTSS symptoms. Particularly, results showed that informal caregivers reported greater PTSS symptoms, when compared to non-caregivers with same levels of fear of COVID-19. This evidence suggests that being a caregiver could increase the fear's impact on PTSS severity in the context of pandemics. Further studies with larger samples are needed to confirm these findings.

Vaccine Acceptance and Its Influencing Factors: An Online Cross-Sectional Study among International College Students Studying in China

BACKGROUND

With the continuous large-scale development of the COVID-19 vaccine, the acceptance of vaccination and its influencing factors at the individual level have become crucial to stemming the pandemic. This study aims to explore the factors that influence the acceptance of the COVID-19 vaccine among international college students.

METHODS

The target population constituted international students pursuing various degrees in Jiangsu Province through an online cross-sectional study. A cluster random sampling was performed using a self-administered questionnaire. The Health Belief Model and Knowledge, Attitude/Beliefs, and Practice Theory served as the underlying theories to understanding the factors that influence vaccine acceptance.

RESULTS

We received 330 responses. About 36.4% intended to accept the vaccine. The acceptance varied across respondents' place of residence, program of study, continent of origin, knowledge, susceptibility, severity, benefits, and cues to action (p < 0.05). A multivariable logistics regression revealed cues to action (p < 0.001), the perception of COVID-19 vaccination benefits (p = 0.002), and the perception of barriers (p < 0.001) that were associated with vaccine acceptance.

CONCLUSIONS

The acceptance of the COVID-19 vaccine was low among international students. The correct and comprehensive beliefs of the target groups regarding the benefits and barriers of the vaccination must be raised. Various effective social strategies must be adopted to trigger the intention of COVID-19 vaccination. The study findings will inform the decisions of public health campaigners, aimed at reducing vaccine hesitation when the COVID-19 vaccine is widely available.