A cross-national and longitudinal analysis of handwashing and its predictors during the COVID-19 pandemic in France and Belgium

Psychosocial determinants of handwashing and physical distancing behaviour during the COVID-19 pandemic in the Netherlands: A longitudinal analysis

OBJECTIVES

Physical distancing and handwashing can be important infection prevention measures during an infectious disease outbreak such as the COVID-19 pandemic. To stimulate these behaviours, knowledge of psychosocial determinants as well as contextual factors is vital. We present longitudinal, within-person analyses of the impact of contextual and psychosocial factors on handwashing and distancing behaviour.

DESIGN

We used individual-level data (186,490 participants completing 971,899 surveys) from the Corona Behavioural Unit COVID-19 Cohort, a dynamic cohort study conducted during 26 months of the COVID-19 pandemic in the Netherlands.

METHODS

Fixed-effects models were employed to estimate within-person associations between psychosocial factors and behaviour, combined with main and moderating effects of contextual factors.

RESULTS

Pandemic severity was associated with more handwashing and distancing behaviour, while the duration of the pandemic had little effect. Within-person changes in response efficacy were most relevant for changes in both handwashing and distancing behaviour, while self-efficacy, descriptive norms and perceived severity of infecting others affected behaviour indirectly. These effects were stable over time. Associations were larger in cross-sectional models, indicating that such models tend to overestimate effects.

CONCLUSIONS

Our study highlights the importance of longitudinal data and within-person models to detect possible causal associations. The results suggest that during an outbreak, government and public health professionals should clearly communicate the severity of the pandemic (e.g., hospitalization rates) and the effectiveness of recommended prevention measures in reducing that risk; and seek to improve people's capabilities and opportunities to adhere to guidelines, for example, by modifying the environment.

Self-reported frequency of handwashing among pet and non-pet owners in different situations: results of four surveys of the general adult population in Germany

BACKGROUND

Zoonotic diseases are partly associated with pets. However, data is sparse on pet owners' compliance with preventive recommendations. Also, research focuses on self-reports, which are subject to overestimation biases, i.e., assessing one's actual performance to be better than it is. One reason is task difficulty: people tend to overestimate their performance on hard tasks. Regarding handwashing, compliance after touching animals should be harder for pet vs. non-pet owners due to the number of opportunities. This study tests for differences in self-reported handwashing between pet and non-pet owners, and explores reasons for non-compliance. Thus, it aims to provide insights on how to improve self-report behavioral assessment methods in public health and One Health research.

METHODS

Data from cross-sectional computer-assisted telephone surveys of the general population in Germany aged 16-85 years in 2012, 2014, 2017 and 2019 were analyzed (N = 15,559; response rate: 45.9%). Handwashing frequency was operationalized for nine indications using the item "How often do you wash your hands in each of the following situations: 'never/almost never', 'seldom', 'mostly', 'always/almost always'?", with the latter defining compliance. In 2017 and 2019, those reporting to 'never/almost never' or 'rarely' wash hands were questioned regarding possible reasons. Chi²-tests, Cohen's d's and multiple logistic regressions were used.

RESULTS

Pet and non-pet owners differed in self-reported handwashing compliance primarily in the indication "After touching animals" (35.5% vs. 55.7%, effect size: d = 0.45). For other indications (e.g., "After using the toilet"), differences were insignificant (≤|3.6%|, d ≤ 0.11). Additionally, 79% of pet owners who rarely or almost never washed their hands after touching animals felt it is not necessary (non-pet owners: 67.1%; d = 0.34). Reporting to not have an appropriate washing facility available was rarer among pet owners (44.5% vs. 63%, d = 0.41). Differences regarding other reasons were trivial (d ≤ 0.16), including "It takes too long" (16.9 vs. 13.3%; p = .138 in multiple regression).

CONCLUSIONS

Study limitations include that due to unknown true compliance, over- and underestimations have to be inferred. Yet, that the only substantial difference between pet and non-pet owners pertained to "After touching animals" suggests such effects. While pet owners obviously adjust for task difficulty, the likely residual overestimation should be reduced by measures using script-based covert recall or survey items with response categories constructed to better resemble subjective compliance ratios.

Trajectories of health behaviors during the COVID-19 pandemic: a longitudinal analysis of handwashing, mask wearing, social contact limitations, and physical distancing

AIM

This study aimed to investigate the associations between health behavior adherence and psychological factors during the COVID-19 pandemic, with a particular focus on identifying trajectories of handwashing, mask wearing, social contact limitations, and physical distancing.

METHODS

We employed a multi-trajectory group-based approach to analyze data from 6026 Belgian residents, including 60% women, with an average age of 52.65. Data were collected over six waves spanning from April 2021 to December 2021.

RESULTS

Participants were categorized into trajectory groups based on persistently low (11.9%), moderate-low (20.9%), moderate-high (39.1%), and high (28.1%) levels of adherence to the specified health behaviors. Our findings indicate a declining trend in health behavior adherence over the study period. Additionally, we observed that females, older individuals, and those with prior COVID-19 infection had a higher likelihood of belonging to trajectory groups characterized by the highest levels of health behavior adherence. Similarly, individuals with positive vaccination intentions, a heightened perception of consequences, and increased health anxiety demonstrated greater adherence to health behaviors over time. Furthermore, our investigation into the relationship between health behaviors and mental health revealed that participants in trajectory groups with higher levels of adherence to social contact limitations and physical distancing reported increased feelings of loneliness and decreased life satisfaction.

CONCLUSIONS

The COVID-19 pandemic has reshaped our lives, and while vaccines have marked progress, maintaining health behaviors is crucial for virus prevention. To address potential mental health challenges from sanitary measures, policies and communication should promote health behaviors while acknowledging their psychological impact.

Predicting health behaviors during the COVID-19 pandemic: A longitudinal study

We investigated the social, emotional, and cognitive predictors of adherence to four health behaviors (handwashing, mask wearing, social contact limitations, and physical distancing) during one critical phase of the COVID-19 pandemic. We collected data (N = 5803, mean age = 53; 57% women) in Belgium at five time points between April and July 2021, a time during which infections evolved from high (third wave of the pandemic) to low numbers of COVID-19 cases. The results show that the social, emotional, and cognitive predictors achieved high levels of explained variance (R2 > .60). In particular, the central components of behavioral change (attitudes, intentions, control, habits, norms, and risk) were the strongest and most consistent predictors of health behaviors over time. Likewise, autonomous motivation and empathetic emotions (e.g., attentive, compassionate) had a positive impact on health behavior adherence, whereas it was the opposite for lively emotions (e.g., active, enthusiastic). These results offer policymakers actionable insights into the most potent and stable factors associated with health behaviors, equipping them with effective strategies to curtail the spread of future infectious diseases.

The role of self-compassion in loneliness during the COVID-19 pandemic: a group-based trajectory modelling approach

Research has suggested an increase in loneliness during the COVID-19 pandemic, but much of this work has been cross-sectional, making causal inferences difficult. In the present research, we employed a longitudinal design to identify loneliness trajectories within a period of twelve months during the COVID-19 pandemic in Belgium (N = 2106). We were particularly interested in the potential protective role of self-compassion in these temporal dynamics. Using a group-based trajectory modelling approach, we identified trajectory groups of individuals following low (11.0%), moderate-low (22.4%), moderate (25.7%), moderate-high (31.3%), and high (9.6%) levels of loneliness. Findings indicated that younger people, women, and individuals with poor quality relationships, high levels of health anxiety, and stress related to COVID-19, all had a higher probability of belonging to the highest loneliness trajectory groups. Importantly, we also found that people high in two of the three facets of self-compassion (self-kindness and common humanity) had a lower probability of belonging to the highest loneliness trajectory groups. Ultimately, we demonstrated that trajectory groups reflecting higher levels of loneliness were associated with lower life satisfaction and greater depressive symptoms. We discuss the possibility that increasing self-compassion may be used to promote better mental health in similarly challenging situations.

Trajectories of self-kindness, common humanity, and mindfulness during the COVID-19 pandemic: A person-oriented multi-trajectory approach

The COVID-19 pandemic has produced unprecedented changes in the lives of many people. Although research has documented associations between concerns related to COVID-19 and poor mental health indicators, fewer studies have focused on positive factors that could help people better cope with this stressful social context. To fill this gap, the present research investigated the trajectories of self-compassion facets in times of dramatic social change. Using a longitudinal research design, we described the trajectories of self-kindness, common humanity, and mindfulness during the first eight months of the COVID-19 pandemic, in a representative sample of Canadian adults (N = 3617). Relying on a multi-trajectory group-based approach, we identified clusters of individuals following persistently low (4.0%), moderate-low (39.3%), moderate-high (46.7%), and high (10.0%) levels of self-kindness, common humanity, and mindfulness. Interestingly, we found that compassionate self-responding trajectories were mainly stable over time with minor fluctuations for some groups of individuals, in line with the epidemiological situation. In terms of covariates, we observed that older women were more likely to follow trajectories of high compassionate self-responding, as compared to the other age and gender groups. In terms of mental health indicators, we demonstrated that trajectory groups with high levels of compassionate self-responding were associated with greater life satisfaction, more happiness, better sleep quality, higher sleep quantity, and fewer negative emotions, as compared to lower trajectory groups. The results supported the idea that self-compassion during the COVID-19 pandemic could have favored better mental health indicators and could possibly be promoted as a psychological intervention in the general population.