Predictors of attitudes and adherence to COVID-19 public health guidelines in Western countries: a rapid review of the emerging literature

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.

Values and preferences in COVID-19 public health guidelines: a systematic review

BACKGROUND

Internationally accepted standards for trustworthy guidelines include the necessity to ground recommendations in values and preferences. Considering values and preferences respects the rights of citizens to participate in health decision-making and ensures that guidelines align with the needs and priorities of the communities they are intended to serve. Early anecdotal reports suggest that COVID-19 public health guidelines did not consider values and preferences. To capture and characterize whether and how COVID-19 public health guidelines considered values and preferences.

METHODS

We performed a systematic review of COVID-19 public health guidelines. We searched the eCOVID-19 RecMap platform-a comprehensive international catalog of COVID-19 guidelines-up to July 2023 and the Guidelines International Network Library-an international library of guidelines published or endorsed by Guidelines International Network member organizations-up to May 2024. We included guidelines that made recommendations addressing vaccination, masking, isolation, lockdowns, travel restrictions, contact tracing, infection surveillance, and school closures. Reviewers worked independently and in duplicate to review guidelines for consideration of values and preferences.

RESULTS

Our search yielded 130 eligible guidelines, of which 41 (31.5%) were published by national organizations, 70 (53.8%) by international organizations, and 19 (14.6%) by professional societies and associations. Twenty-eight (21.5%) guidelines considered values and preferences. Among guidelines that considered values and preferences, most did so to assess the acceptability of recommendations (23; 82.1%) and by referencing published research (25; 89.3%). Guidelines only occasionally engaged laypersons as part of the guideline development group (8; 28.6%). None of the guidelines performed systematic reviews of the literature addressing values and preferences.

CONCLUSION

Most COVID-19 public health guidelines did not consider values and preferences. When they were considered, it was often suboptimal. Disregard for values and preferences might have partly contributed to divisive and unpopular COVID-19 policies. Given the possibility of future health emergencies, we recommend guideline developers identify efficient and effective methods for considering values and preferences in crisis situations.

MEDIC: Development and validation of a new instrument to assess emotional reactivity to medical stimuli in a representative community sample of adults

To support investigation of the etiology and psychophysiology of medical traumatic stress, we developed a standardized set of emotionally-salient medical images, called the 'MEDical Image Collection' (MEDIC), for use in neuroimaging or psychological research. This study aimed to establish internal consistency, test re-test reliability, and congruent validity of the image set. A representative sample of 300 adults in the United States were recruited via research recruitment platform, Prolific. Participants rated 124 images depicting medical stimuli on one of two dimensions: emotional arousal (i.e., how strongly an evoked emotion is felt) or affective valence (i.e., how positive or negative the evoked emotion is). Sociodemographic and health-related characteristics, including experiences during the COVID-19 pandemic, were also assessed. To assess test re-test reliability, a subset (n = 200) rated the images on the same dimension a second time, 3 months later. The MEDIC image set was found to: (a) elicit a range of emotional arousal and valence ratings, (b) have excellent inter-rater reliability, (c) moderate test-retest reliability, and (d) good face validity. Results indicate the new MEDIC 124-image set is a reliable and valid instrument, enabling researchers to provide context-specific and emotionally-salient stimuli to individuals when studying affective responses in relation to health and medicine.

Socioeconomic Status and Adherence to Preventive Measures During the COVID-19 Pandemic in Switzerland: A Population Based Digital Cohort Analysis

Objectives

To assess the association between socioeconomic status (SES) and self-reported adherence to preventive measures in Switzerland during the COVID-19 pandemic.

Methods

4,299 participants from a digital cohort were followed between September 2020 and November 2021. Baseline equivalised disposable income and education were used as SES proxies. Adherence was assessed over time. We investigated the association between SES and adherence using multivariable mixed logistic regression, stratifying by age (below/above 65 years) and two periods (before/after June 2021, to account for changes in vaccine coverage and epidemiological situation).

Results

Adherence was high across all SES strata before June 2021. After, participants with higher equivalised disposable income were less likely to adhere to preventive measures compared to participants in the first (low) quartile [second (Adj.OR, 95% CI) (0.56, 0.37-0.85), third (0.38, 0.23-0.64), fourth (0.60, 0.36-0.98)]. We observed similar results for education.

Conclusion

No differences by SES were found during the period with high SARS-CoV-2 incidence rates and stringent measures. Following the broad availability of vaccines, lower incidence, and eased measures, differences by SES started to emerge. Our study highlights the need for contextual interpretation when assessing SES impact on adherence to preventive measures.

The impact of public transportation on the transmission of COVID-19 in Rwanda

Introduction

The onset of the COVID-19 pandemic has placed a significant burden on healthcare systems worldwide, particularly in sub-Saharan regions where healthcare resources are limited. The transmission of SARS-CoV-2 is facilitated by the movement of people from place to place. Therefore, implementing measures that restrict movement of people and contacts is crucial in controlling the spread of the disease. Following the identification of the first COVID-19 case in Rwanda, the government implemented stringent measures, including a complete nationwide lockdown, border closures, curfews, reduced capacity in public transportation and businesses, and mandatory testing. This study aims to assess epidemiological trends in COVID-19 cases in relation to changes in population mobility within the public transportation system.

Methods

A descriptive analysis using publicly available data on COVID-19 epidemiological indicators (cases, deaths, vaccinations, and stringency index) and mobility data was conducted.

Results

The results reveal a strong correlation between mobility in public transportation and other activities, underscoring Rwanda's reliance on its public transportation system. The study also identifies a pattern where increases in transit station mobility preceded spikes in COVID-19 cases, suggesting that the subsequent rise in public transportation usage may contribute to higher infection rates.

Discussion

Therefore, this study emphasizes the importance of ongoing vigilance and regulatory measures regarding public transportation during infectious disease outbreaks.

Falsification of home rapid antigen lateral flow tests during the COVID-19 pandemic

During the COVID-19 pandemic, lateral flow tests (LFTs) were used to regulate access to work, education, social activities, and travel. However, falsification of home LFT results was a concern. Falsification of test results during an ongoing pandemic is a sensitive issue. Consequently, respondents may not answer truthfully to questions about LFT falsification behaviours (FBs) when asked directly. Indirect questioning techniques such as the Extended Crosswise model (ECWM) can provide more reliable prevalence estimates of sensitive behaviors than direct questioning. Here we report the prevalence of LFT FBs in a representative sample in England (n = 1577) using direct questioning (DQ) and the ECWM. We examine the role of demographic and psychological variables as predictors of LFT FBs. We show that the prevalence estimates of the FBs in the DQ condition were significantly lower than the ECWM estimates, e.g., reporting a negative result without conducting a test: 5.7% DQ vs 18.4% ECWM. Moral norms, subjective norms, anticipated regret, perception of risk to self, and trust in government predicted some of the FBs. Indirect questioning techniques can help provide more realistic and higher quality data about compliance with behavioural regulations to government and public health agencies.

Calculated Comparisons: Manufacturing Societal Causal Judgments by Implying Different Counterfactual Outcomes

How do people come to opposite causal judgments about societal problems, such as whether a public health policy reduced COVID-19 cases? The current research tests an understudied cognitive mechanism in which people may agree about what actually happened (e.g., that a public health policy was implemented and COVID-19 cases declined), but can be made to disagree about the counterfactual, or what would have happened otherwise (e.g., whether COVID-19 cases would have declined naturally without intervention) via comparison cases. Across two preregistered studies (total N = 480), participants reasoned about the implementation of a public policy that was followed by an immediate decline in novel virus cases. Study 1 shows that people's judgments about the causal impact of the policy could be pushed in opposite directions by emphasizing comparison cases that imply different counterfactual outcomes. Study 2 finds that people recognize they can use such information to influence others. Specifically, in service of persuading others to support or reject a public health policy, people systematically showed comparison cases implying the counterfactual outcome that aligned with their position. These findings were robust across samples of U.S. college students and politically and socioeconomically diverse U.S. adults. Together, these studies suggest that implied counterfactuals are a powerful tool that individuals can use to manufacture others' causal judgments and warrant further investigation as a mechanism contributing to belief polarization.

Social identification and risk dynamics: How perceptions of (inter)personal and collective risk impact the adoption of COVID-19 preventative behaviors

Public adoption of preventative behaviors to reduce the transmission of COVID-19 is crucial to managing the pandemic, and so it is vital to determine what factors influence the uptake of those behaviors. Previous studies have identified COVID-19 risk perceptions as a key factor, but this work has typically been limited both in assuming that risk means risk to the personal self, and in being reliant on self-reported data. Drawing on the social identity approach, we conducted two online studies in which we investigated the effects of two different types of risk on preventative measure taking: risk to the personal self and risk to the collective self (i.e., members of a group with which one identifies). Both studies involved behavioral measures using innovative interactive tasks. In Study 1 (n = 199; data collected 27 May 2021), we investigated the effects of (inter)personal and collective risk on physical distancing. In Study 2 (n = 553; data collected 20 September 2021), we investigated the effects of (inter)personal and collective risk on the speed at which tests are booked as COVID-19 symptoms develop. In both studies, we find that perceptions of collective risk, but not perceptions of (inter)personal risk, influence the extent to which preventative measures are adopted. We discuss the implications both conceptually (as they relate to both the conceptualization of risk and social identity processes) and also practically (in terms of the implications for public health communications).

Social Capital and Willingness to Comply With Anti-Pandemic Government Intervention

This study examines the relationship between individual-level social capital and compliance attitudes toward health protective measures in the context of COVID-19. We drew on secondary population-based data fielded during the pandemic's initial phase (April - June of 2020). The analytic sample consists of 9124 older American adults (ages 55 and over) across 18 U.S. States and Metropolitan Statistical Areas. We estimated mixed-effects models with random intercepts and slopes. People who are better socially connected are more willing to comply with anti-pandemic government intervention. This relationship is stronger among those who are more psychologically distressed. Its magnitude also increases in more densely populated areas and places with higher numbers of coronavirus infection. Older Americans' anti-coronavirus compliance attitudes is significantly driven by preexisting interpersonal connectedness and civic engagement. The role of social capital is also contingent on the existing levels of risk factor (threat and vulnerability).

COVID Protection Behaviors, Mental Health, Risk Perceptions, and Control Beliefs: A Dynamic Temporal Network Analysis of Daily Diary Data

BACKGROUND

To control infections, behavioral non-pharmaceutical interventions (NPIs) such as social distancing and hygiene measures (masking, hand hygiene) were implemented widely during the COVID-19 pandemic. At the same time, adherence to NPIs has also been implied in an increase in mental health problems. However, the designs of many existing studies are often poorly suited to disentangle complex relationships between NPI adherence, mental health symptoms, and health-related cognitions (risk perceptions, control beliefs).

PURPOSE

To separate between- and temporal within-person associations between mental health, health-related cognitions, and NPI adherence.

METHODS

Six-month ecological momentary assessment (EMA) study with six 4-day assessment bouts in 397 German adults. Daily measurement of adherence, mental health symptoms, and cognitions during bouts. We used dynamic temporal network analysis to estimate between-person, as well as contemporaneous and lagged within-person effects for distancing and hygiene NPIs.

RESULTS

Distinct network clusters of mental health, health cognitions, and adherence emerged. Participants with higher control beliefs and higher susceptibility were also more adherent (between-person perspective). Within-person, similar findings emerged, additionally, distancing and loneliness were associated. Lagged findings suggest that better adherence to NPIs was associated with better mental health on subsequent days, whereas higher loneliness was associated with better subsequent hygiene adherence.

CONCLUSIONS

Findings suggest no negative impact of NPI adherence on mental health or vice versa, but instead suggest that adherence might improve mental health symptoms. Control beliefs and risk perceptions are important covariates of adherence-both on between-person and within-person level.

Partying during a pandemic: role of descriptive partying norms, residence, college alcohol beliefs, and political ideology in COVID-19 party behavior

OBJECTIVE

Non-adherence to COVID-19 guidelines is a major public health issue. This study explored factors that explain college student party behavior (PB; defined as attending a college party wherein COVID-19 guidelines, including masks and social distancing were ignored) during the pandemic.

METHOD

Freshmen students at a northeastern university (N = 207; 72% women) responded to an online Fall 2020 semester survey.

RESULTS

The percentage of students who participated in on-campus partying during past month was 11.6%, with 20.3% participating in off-campus partying. Living on campus and higher perceived norms for partying were associated with higher levels of on-campus PB, whereas higher perceived norms for partying, stronger college alcohol beliefs, and a more conservative political ideology accounted for significant variance in off-campus PB.

CONCLUSIONS

Efforts to reduce party behavior should target misperception of party behavior norms as well as college alcohol beliefs, and take into account students' residence and political ideology.

The role of general vs pandemic-specific paranoid ideation in the use of recommended health behaviors and vaccine willingness during a worldwide pandemic: An international study in the general public

BACKGROUND

The public's adherence to recommended COVID-19 preventative behaviors, including vaccinations and social distancing, has been low in certain groups and has contributed to many preventable deaths worldwide. An examination of general and pandemic-specific aspects of nonclinical paranoid ideation may aid in the understanding of the public's response to the pandemic, given that it is a global threat event.

METHODS

A representative international sample of general adults (N = 2,510) from five international sites were recruited with stratified quota sampling. Structural equation modeling (SEM) was used to examine the relationships among general paranoid ideation, pandemic paranoid ideation (interpersonal mistrust, conspiratorial thinking, and persecutory threat), general distress (depression, anxiety), vaccine willingness, and other preventative behaviors (masking, social distancing, hygiene).

RESULTS

Although general distress and paranoid ideation were associated with vaccination willingness and preventative behaviors, their effects were inconsistent or weak. Pandemic paranoid ideation showed robust direct and indirect effects that differentially predicted COVID-19 preventative behaviors, with higher interpersonal mistrust associated with higher adherence to all behaviors, higher conspiratorial thinking related to lower adherence to all behaviors, and higher persecutory threat related to higher vaccine willingness, but lower adherence to other preventative behaviors.

CONCLUSIONS

Examination of pandemic-specific paranoid ideation leads to more precise prediction of the public's adherence to recommended health behaviors during the COVID-19 outbreak. This information could be used to inform intervention strategies for micro-targeting different subgroups with nonclinical paranoid thinking, as well as for improving responses to future pandemics and vaccination efforts for other common illnesses.

The Well-Being of Companion Animal Caregivers and Their Companion Animals during the COVID-19 Pandemic: Scoping Review

It is important to understand the effects of the COVID-19 pandemic on animal caregivers and their companion animals in order to inform responses to future crises. Prior research is inconsistent, with the benefits of animal companionship believed to be overstated. In this scoping review, we searched four electronic databases and hand-searched reference lists of included studies. Over 4000 citations were found, and 122 were included in the review. Reflecting on the pre-COVID literature, quantitative evidence of the association between psychological well-being and animal companionship during the pandemic was mixed, with numerous positive, negative, and null findings reported. Studies highlighted the benefits of animal companionship during the pandemic, with animals reported to provide their caregivers with a routine, a sense of greater purpose, a positive distraction from COVID-19, companionship, and emotional support. However, participants also reported concerns about meeting animals' needs, fears of animals catching or spreading the virus, and financial worries. Concerns about what would happen to animals if caregivers were hospitalized led some to delay COVID-19 testing or treatment. Animals also experienced benefits (such as increased companionship and calmer mood) and negative impacts (such as increased clinginess and separation anxiety). Companion animals should be a key consideration in emergency preparedness plans.

Preventative behaviours and COVID-19 infection in a Canadian cohort of people living with HIV

Few studies have examined preventative behaviour practices with respect to COVID-19 among people living with HIV (human immunodeficiency virus). Using a cross-sectional survey from a Canadian Institutes of Health Research Canadian HIV Trials Network study (CTN 328) of people living with HIV on vaccine immunogenicity, we examined the relationships between participant characteristics and behavioural practices intended to prevent COVID-19 infection. Participants living in four Canadian urban centers were enrolled between April 2021-January 2022, at which time they responded to a questionnaire on preventative behaviour practices. Questionnaire and clinical data were combined to explore relationships between preventive behaviours and (1) known COVID-19 infection pre-enrolment, (2) multimorbidity, (3) developing symptomatic COVID-19 infection, and (4) developing symptomatic COVID-19 infection during the Omicron wave. Among 375 participants, 49 had COVID-19 infection pre-enrolment and 88 post-enrolment. The proportion of participants reporting always engaging in preventative behaviours included 87% masking, 79% physical distancing, 70% limiting social gatherings, 65% limiting contact with at-risk individuals, 33% self-isolating due to symptoms, and 26% self-quarantining after possible exposure. Participants with known COVID-19 infection pre-enrolment were more likely to self-quarantine after possible exposure although asymptomatic (65.0% vs 23.4%, p < 0.001; Chi-square test). Participants with multiple comorbidities more likely endorsed physical distancing (85.7% vs 75.5%, p = 0.044; Chi-square test), although this was not significant in logistic regression analysis adjusted for age, sex, race, number of household members, number of bedrooms/bathrooms in the household per person, influenza immunization, and working in close physical proximity to others. Overall, participants reported frequent practice of preventative behaviours.

The effects of the COVID-19 lockdowns on motor skill development of 6- and 7-year old children in the Netherlands: a longitudinal study

BACKGROUND

The closing of schools and sports clubs during the COVID-19 lockdown raised questions about the possible impact on children's motor skill development. Therefore, we compared motor skill development over a one-year period among four different cohorts of primary school children of which two experienced no lockdowns during the study period (control cohorts) and two cohorts experienced one or two lockdowns during the study period (lockdown cohorts).

METHODS

A total of 992 children from 9 primary schools in Amsterdam (the Netherlands) participated in this study (age 5 - 7; 47.5% boys, 52.5% girls). Their motor skill competence was assessed twice, first in grade 3 (T1) and thereafter in grade 4 (T2). Children in control group 1 and lockdown group 1 were assessed a third time after two years (T3). Motor skill competence was assessed using the 4-Skills Test, which includes 4 components of motor skill: jumping force (locomotion), jumping coordination (coordination), bouncing ball (object control) and standing still (stability). Mixed factorial ANOVA's were used to analyse our data.

RESULTS

No significant differences in motor skill development over the study period between the lockdown groups and control groups (p > 0.05) were found, but a difference was found between the two lockdown groups: lockdown group 2 developed significantly better than lockdown group 1 (p = 0.008). While socioeconomic status was an effect modifier, sex and motor ability did not modify the effects of the lockdowns.

CONCLUSIONS

The COVID-19 lockdowns in the Netherlands did not negatively affect motor skill development of young children in our study. Due to the complexity of the factors related to the pandemic lockdowns and the dynamic systems involved in motor skill development of children, caution must be taken with drawing general conclusions. Therefore, children's motor skill development should be closely monitored in the upcoming years and attention should be paid to individual differences.

Opiate maintenance patients' attitudes and self-reported adherence to protective measures against SARS-CoV-2 infections

Background

During the COVID-19 pandemic we assessed to which extent patients in opioid maintenance treatment (OMT) adhere to official recommendations regarding preventive intervention strategies against COVID-19.

Methods

Patients enrolled in two OMT clinics in Germany were interviewed applying a standardized questionnaire, which covered socio-demographic information, recent psychotropic substance use, recent social activities, the history of SARS-CoV-2 infection, attitudes toward official protection recommendations, and levels of adherence to these suggestions. Current mental and medical diagnoses were retrieved from medical files. In subjects without known infection and without vaccination, blood samples were tested for the identification of anti-SARS-CoV-2-S-antibodies. Interviews were performed between the end of May and the end of September 2021.

Results

Patients' (n = 155) average age was 47 years; 74% were males. In addition to the opiate dependence, in nearly 80% of cases another medical disorder was recorded. The range of medical factors that predispose for severe COVID-19 outcomes were present in 39% of patients; 18% of the sample refused to be vaccinated. Nearly all patients reported having carried out a range of activities outside their residence during the week prior to the interviews, including visits of treatment facilities (86.5%; 95% confidence interval [80.2%; 91.0%]) or meeting with friends (64.5% [65.7-71.6%]). Despite the fact that only about 47.1% [39.2%; 55%] felt well informed about measures against infection, adherence to COVID-19 countermeasures was generally high: 83.9% [77.3; 88.8%] claimed to have worn face masks always/nearly always; social distancing was performed always/nearly always by 58.7% [50.8%; 66.2%]; and hand hygiene was conducted by 64.5% [56.7%; 71.6%] of participants. None out of n = 25 tests from unvaccinated subjects was positive for anti-SARS-CoV-2-S-antibodies. Psychiatric comorbidity and educational degree were not statistically significantly associated with attitudes and compliance, except that patients with lower education felt relatively worse informed.

Conclusion

Self-reported adherence to recommended non-therapeutic intervention strategies and vaccination rates were similar to the German general population. Provision of more health-related information tailored to OMT patients appears necessary.

Psychological and psychosocial determinants of COVID Health Related Behaviours (COHeRe): An evidence and gap map

Background

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has resulted in illness, deaths and societal disruption on a global scale. Societies have implemented various control measures to reduce transmission of the virus and mitigate its impact. Individual behavioural changes are crucial to the successful implementation of these measures. Common recommended measures to limit risk of infection include frequent handwashing, reducing the frequency of social interactions and the use of face coverings. It is important to identify those factors that can predict the uptake and maintenance of these protective behaviours.

Objectives

We aimed to identify and map the existing evidence (published and unpublished) on psychological and psychosocial factors that determine uptake and adherence to behaviours aimed at reducing the risk of infection or transmission of COVID-19.

Search Methods

Our extensive search included electronic databases (n = 12), web searches, conference proceedings, government reports, other repositories including both published peer reviewed, pre-prints and grey literature. The search strategy was built around three concepts of interest including (1) context (terms relating to COVID-19), (2) behaviours of interest and (3) terms related to psychological and psychosocial determinants of COVID Health-Related Behaviours and adherence or compliance with recommended behaviours, to capture both malleable and non-malleable determinants (i.e. determinants that could be changed and those that could not).

Selection Criteria

This Evidence and Gap Map (EGM) includes all types of studies examining determinants of common recommended behaviours aimed at mitigating human-to-human spread of COVID-19. All potential malleable and non-malleable determinants of one or more behaviours are included in the map. As part of the mapping process, categories are used to group determinants. The mapping categories were based on a previous rapid review by Hanratty 2021. These include: 'behaviour', 'cognition', 'demographics', 'disease', 'emotions', 'health status', 'information', 'intervention', and 'knowledge'. Those not suitable for categorisation in any of these groups are included in the map as 'other' determinants.

Data Collection and Analysis

Results were imported to a bibliographic reference manager where duplications of identical studies gathered from multiple sources were removed. Data extraction procedures were managed in EPPI-Reviewer software. Information on study type, population, behaviours measured and determinants measured were extracted. We appraised the methodological quality of systematic reviews with AMSTAR-2. We did not appraise the quality of primary studies in this map.

Main Results

As of 1 June 2022 the EGM includes 1034 records reporting on 860 cross-sectional, 68 longitudinal, 78 qualitative, 25 reviews, 62 interventional, and 39 other studies (e.g., mixed-methods approaches). The map includes studies that measured social distancing (n = 487), masks and face coverings (n = 382), handwashing (n = 308), physical distancing (n = 177), isolation/quarantine (n = 157), respiratory hygiene/etiquette (n = 75), cleaning surfaces (n = 59), and avoiding touching the T-zone (n = 48). There were 333 studies that assessed composite measures of two or more behaviours. The largest cluster of determinants was 'demographics' (n = 730 studies), followed by 'cognition' (n = 496 studies) and determinants categorised as 'other' (n = 447). These included factors such as 'beliefs', 'culture' and 'access to resources'. Less evidence is available for some determinants such as 'interventions' (n = 99 studies), 'information' (n = 101 studies), and 'behaviour' (149 studies).

Authors' Conclusions

This EGM provides a valuable resource for researchers, policy-makers and the public to access the available evidence on the determinants of various COVID-19 health-related behaviours. The map can also be used to help guide research commissioning, by evidence synthesis teams and evidence intermediaries to inform policy during the ongoing pandemic and potential future outbreaks of COVID-19 or other respiratory infections. Evidence included in the map will be explored further through a series of systematic reviews examining the strength of the associations between malleable determinants and the uptake and maintenance of individual protective behaviours.

Public knowledge, attitudes, and practices during the first wave of COVID-19 in Indonesia

Background

The COVID-19 pandemic became a global emergency, and it is vital to understand the knowledge, attitudes, and practices of populations regarding this disease to prevent its spread.

Objective

The study aimed to investigate the knowledge, attitudes, and practices of the Indonesian public toward COVID-19.

Methods

An observational study was conducted in Indonesia between November 2020 and January 2021. The study employed a validated questionnaire with 391 respondents to the survey. A comparative analysis was performed to assess the mean differences in respondents' characteristics in terms of their knowledge, attitude, and practice scores. Furthermore, regression analysis was used to investigate those factors associated with the good practice of health protocols during the COVID-19 pandemic.

Results

The findings showed significant differences in the average knowledge scores across gender, geographical location, and educational attainment. Furthermore, significant differences in practices were identified in terms of gender and educational attainment. The findings of the study indicate that the participants demonstrated a significant awareness of COVID-19, as evidenced by their high mean knowledge score of 17.83 ± 1.74 out of a possible total score of 22 points. The results indicate that the respondents exhibited a positive attitude toward COVID-19 prevention measures, as evidenced by an attitude score of 26.95 ± 3.14 out of a possible total score of 30 points. Additionally, the mean score for good practice in health protocols aimed at reducing COVID-19 infection was found to be high (4.23 ± 0.96) at 5 points. This suggests that the study participants had already adopted effective measures to comply with the recommended health guidelines. The results of the regression analysis indicated that gender, level of education, and knowledge were statistically significant predictors for adherence to health protocols during the COVID-19 pandemic (p < 0.05).

Conclusion

The aforementioned results offer significant perspectives into the populace's comprehension, disposition, and conduct regarding COVID-19 in Indonesia. These insights could potentially contribute to the formulation of efficacious measures aimed at curtailing transmission of the virus.

The Agile Co-production and Evaluation framework for developing public health interventions, messaging and guidance

A lesson identified from the COVID-19 pandemic is that we need to extend existing best practice for intervention development. In particular, we need to integrate (a) state-of-the-art methods of rapidly coproducing public health interventions and messaging to support all population groups to protect themselves and their communities with (b) methods of rapidly evaluating co-produced interventions to determine which are acceptable and effective. This paper describes the Agile Co-production and Evaluation (ACE) framework, which is intended to provide a focus for investigating new ways of rapidly developing effective interventions and messaging by combining co-production methods with large-scale testing and/or real-world evaluation. We briefly review some of the participatory, qualitative and quantitative methods that could potentially be combined and propose a research agenda to further develop, refine and validate packages of methods in a variety of public health contexts to determine which combinations are feasible, cost-effective and achieve the goal of improving health and reducing health inequalities.

Sociodemographic and clinical predictors for COVID-19 preventive measures compliance among pregnant women in Saudi Arabia: a multicenter study

OBJECTIVE

To assess the levels of adherence among pregnant women to the basic COVID-19 preventive measures, and to analyze the effect of risk perception and sociodemographic and clinical factors on adherence.

METHOD

A multicenter, cross-sectional study was conducted at the obstetrics clinics of 50 primary care centers selected using a multistage sampling method. An online-administered, structured questionnaire was used to collect self-reported levels of adherence to four basic preventive measures against COVID-19, along with perceived COVID-19 severity, infectiousness, and harmfulness to the baby, besides sociodemographic and clinical data including obstetrical and other medical history.

RESULTS

A total of 2460 pregnant women were included with a mean (SD) age of 30.21 (6.11) years. Levels of self-reported compliance were highest for hand hygiene (95.7%), followed by social distancing (92.3%), masking (90.0%), and avoidance of contact with a COVID-19 infected person (70.3%). Perceived COVID-19 severity and infectiousness, and harmfulness to the baby were observed in 89.2%, 70.7%, and 85.0% of the participants, respectively, and were variably associated with compliance to preventive measures. Analysis of sociodemographic factors highlighted the significance of education and economic status in determining adherence to preventive measures, which represents a potential inequity in the risk of COVID-19 infection.

CONCLUSION

This study highlights the importance of patients' education to enable functional perception of COVID-19 that promotes self-efficacy, besides investigating the specific social determinants of health to tackle inequalities in terms of prevention efficiency and the subsequent health outcomes.

COVID-19 Prevention Behaviours and Vaccine Acceptability, and Their Association with a Behaviour Change Campaign in Somalia: Analysis of a Longitudinal Cohort

Somalia experienced its first wave of COVID-19 infections in March 2020 and has experienced fluctuating infection levels since. Longitudinal data on suspected cases of COVID-19, attitudes, and behaviours were collected by telephone interviews of cash-transfer programme beneficiaries from June 2020-April 2021. A multi-media Social and Behaviour Change Communication (SBCC) campaign was designed and implemented from February 2021 to May 2021. Between the end of the first wave and the onset of the second the perceived threat from COVID-19 increased, with the proportion of respondents viewing it as a major threat increasing from 46% to 70% (p = 0.021). Use of face coverings increased by 24% (p < 0.001) and hand shaking and hugging for social greeting decreased, with 17% and 23% more people abstaining from these practices (p = 0.001). A combined preventative behaviour score (PB-Score) increased by 1.3 points (p < 0.0001) with a higher score in female respondents (p < 0.0001). During wave 2, vaccine acceptance was reported by 69.9% (95% CI 64.9, 74.5), overall. Acceptance decreased with increasing age (p = 0.009) and was higher in males (75.5%) than females (67.0%) (p = 0.015). Awareness of the SBCC campaign was widespread with each of the 3 key campaign slogans having been heard by at least 67% of respondents. Awareness of 2 specific campaign slogans was independently associated with an increased use of face coverings (aOR 2.31; p < 0.0001) and vaccine acceptance (aOR 2.36; p < 0.0001). Respondents reported receiving information on the pandemic from a wide range of sources with mobile phones and radio the most common. Trust in different sources ranged widely.

Demographic, structural, and psychological predictors of risk-increasing and mask wearing behaviors among US adults between December 2020-March 2021

OBJECTIVES

To assess demographic, structural, and psychological predictors of risk-increasing and risk-decreasing behaviors METHODS: This study used data from an online longitudinal, three-wave COVID-19 survey (12/20-03/21) regarding the behaviors, attitudes, and experiences of US Veteran (n = 584) and non-Veteran (n = 346) adults.

RESULTS

Inability to get groceries delivered emerged as the strongest predictor of more frequent risk-increasing behavior across all timepoints. Other consistent predictors of more frequent risk-increasing behavior and less frequent mask wearing included less worry about getting COVID-19, disbelief in science, belief in COVID-19 conspiracies, and negative perceptions of the state response. No demographic factor consistently predicted risk-increasing behavior or mask wearing, though different demographic predictors emerged for more frequent risk-increasing behaviors (e.g., lower health literacy) and mask-wearing (e.g., older age and urban residence) at certain timepoints. The most frequently endorsed reasons for having contact with others concerned health-related (food, medical care, and exercise) and social needs (seeing friends/family and boredom).

CONCLUSIONS

These findings highlight key individual-level determinants of risk-increasing behaviors and mask wearing which encompass demographic, structural, and psychological factors.

PRACTICE IMPLICATIONS

Findings can support public health experts and health communicators promote engagement with risk-reducing behaviors and address key barriers to engaging in these behaviors.

Covering the Distance: A Study of Parent and Teen Attitudes on COVID-19 Mitigation Measures During the COVID-19 Pandemic

Background The Unity® Consortium surveyed teens and parents and guardians of teens across the country at three distinct time points or waves during the COVID-19 pandemic to assess participant attitudes and beliefs regarding COVID-19 mitigation guidelines, such as mask-wearing and physical distancing. Methodology A third-party market research company conducted 15-minute, online surveys from nationally representative panels. Surveys were conducted at three distinct time points or waves (August 2020, February 2021, and June 2021) with 300 teens aged 13-18 years in each wave and 593/531/500 parents and guardians of teens aged 13-18 years in each wave, respectively. Participants responded using a five-point Likert scale (strongly agree to strongly disagree) on their COVID-19 experiences, including the perceived importance of strictly following mask-wearing and/or social distancing guidelines and the perceived effectiveness of mask-wearing and social distancing in preventing the spread of COVID-19. Data were analyzed for differences across waves and demographic variables. Statistical analyses included frequencies, analysis of variance (ANOVA), and t-tests/z-tests. Results While significantly more parents and teens in Waves 2 and 3 knew someone who was hospitalized or died due to COVID-19 compared to Wave 1, significantly fewer in Wave 3 reported experiencing a lot or some stress and worry regarding the pandemic. By Wave 3, 58% of teens and 56% of parents had received at least one dose of a COVID-19 vaccine. Despite changes in experiences over time, a significant majority of parents and teens consistently agreed on the importance and effectiveness of social distancing and masking guidelines against the spread of COVID-19. In Wave 3, the demographic variables significantly associated with agreement on importance included race (Black (92%) > White (80%)), community type (urban (91%) > suburban (79%) and rural (73%)), and positive vaccination status of parents and teens (92%/89%) > not vaccinated (73%/73%), respectively). The demographic variables significantly associated with agreement on effectiveness included race (Black (91%) > White (81%)), community type (urban (89%) > suburban (83%) and rural (71%)), and positive vaccination status of parents and teens (94%/90% > not vaccinated (72%/70%), respectively). Conclusions This study into the perceived importance and perceived effectiveness of mitigation strategies during the COVID-19 pandemic revealed differences in attitudes among sociodemographic groups. Understanding these differences can help shape how adherence to public health guidelines in a pandemic is promoted.

Predictors of changing patterns of adherence to containment measures during the early stage of COVID-19 pandemic: an international longitudinal study

BACKGROUND

Identifying common factors that affect public adherence to COVID-19 containment measures can directly inform the development of official public health communication strategies. The present international longitudinal study aimed to examine whether prosociality, together with other theoretically derived motivating factors (self-efficacy, perceived susceptibility and severity of COVID-19, perceived social support) predict the change in adherence to COVID-19 containment strategies.

METHOD

In wave 1 of data collection, adults from eight geographical regions completed online surveys beginning in April 2020, and wave 2 began in June and ended in September 2020. Hypothesized predictors included prosociality, self-efficacy in following COVID-19 containment measures, perceived susceptibility to COVID-19, perceived severity of COVID-19 and perceived social support. Baseline covariates included age, sex, history of COVID-19 infection and geographical regions. Participants who reported adhering to specific containment measures, including physical distancing, avoidance of non-essential travel and hand hygiene, were classified as adherence. The dependent variable was the category of adherence, which was constructed based on changes in adherence across the survey period and included four categories: non-adherence, less adherence, greater adherence and sustained adherence (which was designated as the reference category).

RESULTS

In total, 2189 adult participants (82% female, 57.2% aged 31-59 years) from East Asia (217 [9.7%]), West Asia (246 [11.2%]), North and South America (131 [6.0%]), Northern Europe (600 [27.4%]), Western Europe (322 [14.7%]), Southern Europe (433 [19.8%]), Eastern Europe (148 [6.8%]) and other regions (96 [4.4%]) were analyzed. Adjusted multinomial logistic regression analyses showed that prosociality, self-efficacy, perceived susceptibility and severity of COVID-19 were significant factors affecting adherence. Participants with greater self-efficacy at wave 1 were less likely to become non-adherence at wave 2 by 26% (adjusted odds ratio [aOR], 0.74; 95% CI, 0.71 to 0.77; P < .001), while those with greater prosociality at wave 1 were less likely to become less adherence at wave 2 by 23% (aOR, 0.77; 95% CI, 0.75 to 0.79; P = .04).

CONCLUSIONS

This study provides evidence that in addition to emphasizing the potential severity of COVID-19 and the potential susceptibility to contact with the virus, fostering self-efficacy in following containment strategies and prosociality appears to be a viable public health education or communication strategy to combat COVID-19.

Persuasive Messages for Improving Adherence to COVID-19 Prevention Behaviors: Randomized Online Experiment

BACKGROUND

Adherence to nonpharmaceutical interventions for COVID-19, including physical distancing, masking, staying home while sick, and avoiding crowded indoor spaces, remains critical for limiting the spread of COVID-19.

OBJECTIVE

The aim of this study was to test the effectiveness of using various persuasive appeals (deontological moral frame, empathy, identifiable victim, goal proximity, and reciprocity) at improving intentions to adhere to prevention behaviors.

METHODS

A randomized online experiment using a representative sample of adult Canadian residents with respect to age, ethnicity, and province of residence was performed from March 3 to March 6, 2021. Participants indicated their intentions to follow public health guidelines, saw one of six flyers featuring a persuasive appeal or no appeal, and then rated their intentions a second time. Known correlates of attitudes toward public health measures were also measured.

RESULTS

Intentions to adhere to public health measures increased in all appeal conditions. The message featuring an empathy appeal resulted in a greater increase in intentions than the control (no appeal) message. Moreover, the effectiveness of persuasive appeals was moderated by baseline intentions. Deontological, empathy, identifiable victim, and reciprocity appeals improved intentions more than the control message, but only for people with lower baseline intentions to adhere to nonpharmaceutical interventions.

CONCLUSIONS

Public health marketing campaigns aiming to increase adherence to COVID-19 protective behaviors could achieve modest gains by employing a range of persuasive appeals. However, to maximize impact, it is important that these campaigns be targeted to the right individuals.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05722106; https://clinicaltrials.gov/ct2/show/NCT05722106.

Role of individual characteristics and national distancing policies for COVID-19 protective behaviour among older adults: a cross-sectional study of 27 European countries

OBJECTIVE

Evidence on how individual characteristics and distancing policies during the first wave of COVID-19 together influenced health behaviours is scarce. The objective of this study is to fill in this gap by studying how the propensity to engage in protective behaviours in Europe was shaped by the interplay of individual characteristics and national policies.

DESIGN

Data on individual behaviour in 27 countries came from the 'Corona Survey' module of the Survey of Health, Ageing and Retirement in Europe, collected in summer 2020. As outcomes, we considered avoidant behaviours (never leaving home, reducing frequency of walks and reducing frequency of social meetings) and preventive behaviour (wearing a face mask). Among relevant policies, we considered stay-at-home restrictions, mask wearing policies and gathering restrictions. Individual characteristics comprised gender, health risk of COVID-19 (older age and poor health) and activity (employment and providing help to other households).

PARTICIPANTS

Nationally representative samples of older adults (50 years and over), n=51 540 respondents (58% of women).

RESULTS

Active people (employed and helping other households) were more likely to wear face masks but less likely to use avoidant behaviours. People at health risk (older people and those in poor health) were more likely to use all types of protective behaviours. Protective behaviours were also more frequent among women than among men. Longer duration of distancing polices correlated with more frequent protective behaviours. Distancing policies reduced social differences in the rate of protective behaviours only in case of social meetings and mask wearing.

CONCLUSIONS

Protective behaviours responded to distancing policies, but our results suggest that people used them voluntarily, especially if they were at health risk.

The effects of comorbidities on the change of taste and smell in COVID-19 patients

Background

Sudden chemosensory changes were considered an early predictor of COVID-19. Here, the effects of comorbidities on changes in taste and smell in COVID-19 patients were investigated based on a worldwide study.

Methods

Data analyzed here were collected from the Global Consortium for Chemosensory Research (GCCR) core questionnaire, including questions regarding preexisting disease conditions. Overall, the final sample of 12,438 participants who were diagnosed with COVID-19 included patients with preexisting conditions. Mixed linear regression models were used to test our hypothesis, and the p-value of interaction was examined.

Results

A total of 61,067 participants completed the GCCR questionnaire, including 16,016 participants had preexisting diseases. The multivariate regression analysis showed that individuals with high blood pressure, lung disease, or sinus problems, or neurological diseases exhibited worse self-reported smell loss (p < .05), but no apparent significant differences in the smell or taste recovery. COVID-19 patients with seasonal allergy/hay fever lost their olfactory ability more than patients who did not have it (with 11.90 [9.67, 14.13] vs. without 6.97 [6.04, 7.91], p < .0001). The taste ability, smell loss and taste loss after COVID-19 recovery also decreased in the COVID-19 patients with seasonal allergy/hay fever (p < .001). Preexisting condition of diabetes did not worsen to chemosensory disorder but also had no obvious impact on the chemosensory recovery after acute infection. Preexisting diseases also affected the type of smell change in the COVID-19 patients with seasonal allergy/hay fever or sinus problems (p < .05).

Conclusions

COVID-19 patients with high blood pressure, lung disease, or sinus problems, or neurological diseases exhibited worse self-reported smell loss, but no differences in the smell or taste recovery. COVID-19 patients with seasonal allergy/hay fever had greater loss of smell and taste, poorer smell and taste recovery.

Level of Evidence

4.

Application of the Capability, Opportunity, Motivation and Behavior (COM-B) model to identify predictors of two self-reported hand hygiene behaviors (handwashing and hand sanitizer use) to prevent COVID-19 infection among U.S. adults, Fall 2020

BACKGROUND

Handwashing with soap and water is an important way to prevent transmission of viruses and bacteria and worldwide it is estimated handwashing can prevent 1 in 5 viral respiratory infections. Frequent handwashing is associated with a decreased risk for infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Using a hand sanitizer with at least 60% alcohol when handwashing is not feasible can also help prevent the transmission of viruses and bacteria.

OBJECTIVE

Since early 2020, the public has been encouraged to handwash frequently with soap and water and use alcohol-based hand sanitizer when soap and water are not available to reduce COVID-19 transmission. This study's objectives were to assess U.S. adults' perceptions of components of the Capability, Opportunity, Motivation and Behavior (COM-B) Model in relation to these two hand hygiene behaviors and to identify relationships between these components and hand hygiene behaviors.

METHODS

Items assessing capability, opportunity, motivation, and hand hygiene behaviors were included in FallStyles, a survey completed by 3,625 adults in the fall of 2020 through an online panel representative of the U.S.

POPULATION

We calculated composite capability, opportunity, and motivation measures and descriptive statistics for all measures. Finally, we conducted multiple logistic regressions to identify predictors of handwashing and hand sanitizer use.

RESULTS

Most respondents reported frequently washing hands with soap and water (89%) and using alcohol-based hand sanitizer (72%) to prevent coronavirus. For capability, over 90% of respondents said that neither behavior takes a lot of effort, but fewer agreed that they knew when, or how, they should engage in handwashing (67%; 74%) and hand sanitizer use (62%; 64%). For opportunity, over 95% of respondents said lack of time didn't make it hard to engage in either behavior; fewer said visual cues reminded them to engage in the behaviors (handwashing: 30%; sanitizer use: 48%). For motivation, the majority believed the two behaviors were good ways to prevent coronavirus illness (handwashing: 76%; sanitizer use: 59%). Regressions indicated that capability, opportunity, and particularly motivation were positively associated with both hand hygiene behaviors.

CONCLUSIONS

The COM-B model was a helpful framework for increasing understanding of hand hygiene behavior; it identified capability, opportunity, and motivation as predictors of both handwashing and hand sanitizer use.

Effectiveness of non-pharmaceutical interventions to reduce SARS-CoV-2 transmission in Canada and their association with COVID-19 hospitalization rates

Background

Non-pharmaceutical interventions (NPIs) aim to reduce the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections mostly by limiting contacts between people where virus transmission can occur. However, NPIs limit social interactions and have negative impacts on economic, physical, mental and social well-being. It is, therefore, important to assess the impact of NPIs on reducing the number of coronavirus disease 2019 (COVID-19) cases and hospitalizations to justify their use.

Methods

Dynamic regression models accounting for autocorrelation in time series data were used with data from six Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Québec) to assess 1) the effect of NPIs (measured using a stringency index) on SARS-CoV-2 transmission (measured by the effective reproduction number), and 2) the effect of the number of hospitalized COVID-19 patients on the stringency index.

Results

Increasing stringency index was associated with a statistically significant decrease in the transmission of SARS-CoV-2 in Alberta, Saskatchewan, Manitoba, Ontario and Québec. The effect of stringency on transmission was time-lagged in all of these provinces except for Ontario. In all provinces except for Saskatchewan, increasing hospitalization rates were associated with a statistically significant increase in the stringency index. The effect of hospitalization on stringency was time-lagged.

Conclusion

These results suggest that NPIs have been effective in Canadian provinces, and that their implementation has been, in part, a response to increasing hospitalization rates of COVID-19 patients.

Methodological guidance for incorporating equity when informing rapid-policy and guideline development

OBJECTIVES

We provide guidance for considering equity in rapid reviews through examples of published COVID-19 rapid reviews.

STUDY DESIGN AND SETTING

This guidance was developed based on a series of methodological meetings, review of internationally renowned guidance such as the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for equity-focused systematic reviews (PRISMA-Equity) guideline. We identified Exemplar rapid reviews by searching COVID-19 databases and requesting examples from our team.

RESULTS

We proposed the following key steps: 1. involve relevant stakeholders with lived experience in the conduct and design of the review; 2. reflect on equity, inclusion and privilege in team values and composition; 3. develop research question to assess health inequities; 4. conduct searches in relevant disciplinary databases; 5. collect data and critically appraise recruitment, retention and attrition for populations experiencing inequities; 6. analyse evidence on equity; 7. evaluate the applicability of findings to populations experiencing inequities; and 8. adhere to reporting guidelines for communicating review findings. We illustrated these methods through rapid review examples.

CONCLUSION

Implementing this guidance could contribute to improving equity considerations in rapid reviews produced in public health emergencies, and help policymakers better understand the distributional impact of diseases on the population.

Longitudinal changes in COVID-19 concern and stress: Pandemic fatigue overrides individual differences in caution

Background:

Pandemic fatigue describes a phenomenon whereby individuals experience a decrease in COVID-19 concern over time, despite their risk for infection remaining stable, or even increasing. Individual differences in the experience of pandemic fatigue may have important implications for people’s adherence to public health recommendations.

Design and methods:

Using data collected from a large community cohort in McLennan County, TX, longitudinal changes in COVID-19-related concern, stress, and affect across three appointments separated by approximately 4 weeks (July–November 2020) were examined. About 495, 349, and 286 participants completed one, two, and three appointments, respectively. Changes to stress physiology and local travel over time were also analyzed.

Results:

Results of a latent class growth analysis revealed four distinct classes of individuals: (a) low concern, low stress, (b) moderate concern, moderate stress, (c) moderate concern, low stress, and (d) high concern, high stress. Despite differences between latent classes in initial levels of concern, stress, and negative affect, levels of each variable decreased over time for all groups. While this reduction of concern did not coincide with changes in local travel, it was reflected in heart rate and blood pressure.

Conclusions:

Together, these results suggest a general trend of pandemic fatigue in the sample, even for those with moderate-to-high levels of initial COVID-19 stress and concern. Such findings may provide insights into the expected challenges of promoting compliance with public health recommendations as the pandemic continues.

Attitudes toward COVID-19 Pandemic among Fully Vaccinated Individuals: Evidence from Greece Two Years after the Pandemic

Background

Considering the major effects of COVID-19 pandemic on health, social, economic, and political dimensions of all countries, positive attitudes toward COVID-19 pandemic are essential to control the pandemic. In our study, we investigated attitudes toward COVID-19 pandemic among fully COVID-19 vaccinated individuals two years after the pandemic and we identified predictors of attitudes.

Materials and Methods

We conducted an on-line cross-sectional study with 815 fully COVID-19 vaccinated individuals in Greece during May 2022. A self-administered and valid questionnaire was disseminated through social media platforms. We measured socio-demographic variables and COVID-19-related variables as potential predictors of attitudes toward COVID-19 pandemic. The outcome variable was attitudes toward COVID-19 pandemic (compliance with hygiene measures, trust in COVID-19 vaccination, fear of COVID-19, and information regarding the COVID-19 pandemic and vaccination).

Results

We found a very high level of compliance with hygiene measures, a high level of trust and information about the COVID-19 pandemic and vaccination, and a moderate level of fear of COVID-19. Also, we identified that females, participants with a higher educational level, those with a chronic disease, those with a better self-perceived physical health, and those without a previous COVID-19 diagnosis adhered more in hygiene measures. Trust in COVID-19 vaccination was higher among females, older participants, those with a higher educational level, those with a better self-perceived physical health, and those without a previous COVID-19 diagnosis. Moreover, females, older participants, those with a higher educational level, those with a chronic disease, those with a better self-perceived physical health, those that received a flu vaccine in previous season, and those without a previous COVID-19 diagnosis experienced more fear of COVID-19. Finally, level of information regarding COVID-19 pandemic and vaccination was higher for participants with a higher educational level, those without a chronic disease, those with a better self-perceived physical health, and those that received a flu vaccine in previous season.

Conclusions

Understanding predictors of attitudes toward COVID-19 pandemic among fully vaccinated individuals is crucial for developing appropriate public health campaigns in the future. Vaccination should be accompanied by positive attitudes in order to decrease the frequency of negative outcomes of COVID-19, such as hospitalization, complications and mortality.

Associations between Lifestyle Changes and Adherence to COVID-19 Restrictions in Older Adults with Hypertension

COVID-19 has changed people’s routines and imposed new ways of living. This study investigated variations in lifestyles (namely, physical activity, diet, alcohol consumption, and cigarette smoking) between the prepandemic and the pandemic period in a sample of older adults with hypertension. Moreover, it investigated predictors of adherence to government restrictions during the first lockdown period, evidencing the role of relevant sociodemographic indicators and lifestyle changes. A sample of 105 older Italian adults (M_age = 70 years; SD = 5.83) with hypertension was enrolled from a previous longitudinal study and interviewed on the phone between May and August 2020. Updated information about sociodemographic indicators and lifestyle changes was collected. Adherence to restrictions was explored through several questions regarding compliance with home confinement, facemask use, and the observance of social distancing. Results evidenced that only 33% of the respondents abided by all the national restrictions. During the first pandemic peak, considerable changes in lifestyles occurred, particularly regarding physical activity, which diminished in 70% of the sample. Women, unemployed/retired people, and individuals who decreased their amount of physical activity reported higher adherence to rules. Maintaining a healthy lifestyle over time is essential for disease prevention. Therefore, it is essential to continue to inform the population about the importance of a healthy lifestyle, and it is necessary to provide guidelines to maintain and promote it even during housebound periods.

Impact of stringent non-pharmaceutical interventions applied during the second and third COVID-19 epidemic waves in Portugal, 9 November 2020 to 10 February 2021: an ecological study

Background

Non-pharmaceutical interventions (NPIs) were implemented worldwide to control the spread of SARS-CoV-2.

Aim

To evaluate the impact of tiered NPIs and a nationwide lockdown on reduction of COVID-19 incidence during the second and third epidemic waves in Portugal.

Methods

Surveillance data on laboratory-confirmed COVID-19 cases were used to conduct an interrupted time series analysis to estimate changes in daily incidence during a second wave tiered NPI period (9 November–18 December 2020), and a third wave lockdown period without (15–21 January 2021) and with school closure (22 January–10 February 2021).

Results

Significant changes in trends were observed for the overall incidence rate; declining trends were observed for tiered NPIs (−1.9% per day; incidence rate ratio (IRR): 0.981; 95% confidence interval (CI): 0.973–0.989) and a lockdown period without (−3.4% per day; IRR: 0.966; 95% CI: 0.935–0.998) and with school closure (−10.3% per day, IRR: 0.897; 95% CI: 0.846–0.951). Absolute effects associated with tiered NPIs and a lockdown on a subsequent 14-day period yielded 137 cases and 437 cases per 100,000 population potentially averted, respectively.

Conclusion

Our results indicate that tiered NPIs implemented during the second wave caused a decline in COVID-19 incidence, although modest. Moreover, a third wave lockdown without school closure was effective in reducing COVID-19 incidence, but the addition of school closure provided the strongest effect. These findings emphasise the importance of early and assertive decision-making to control the pandemic.

Barriers and facilitators of willingness to vaccinate against COVID-19: Role of prosociality, authoritarianism and conspiracy mentality. A four-wave longitudinal study

AIM

We investigated longitudinal relations between individual willingness to undergo vaccination against COVID-19 and three social factors: conspiracy mentality, prosociality, and authoritarianism.

METHOD

This longitudinal study comprised four measurement points. The first wave sample included 1130 responses and was representative of the Polish population in terms of gender, age, and place of residence. Analyses were performed using random intercept cross-lagged panel models.

RESULTS

We observed bidirectional positive cross-lagged relationships between prosociality and willingness to undergo vaccination in the first three waves of measurement. Authoritarianism and conspiracy mentality translated into a lower willingness to vaccinate between the third and fourth points of measurement when the vaccination became a near-term possibility.

CONCLUSIONS

Eliciting prosocial motivation to vaccinate can be paramount in overcoming vaccine hesitancy. Because conspiracy thinking may be a crucial barrier to willingness to be vaccinated, it is critical to focus on planning interventions and campaigns undermining conspiracy theories about COVID-19.

Higher risk, higher protection. COVID-19 risk among immigrants in France: results from the population-based EpiCov survey

Background

Immigrants and ethnic/racialized minorities have been identified as being at higher risk of coronavirus disease-19 (COVID-19) infection, but few studies report on their exposures and prevention behaviours. This study aims to examine the social distribution of COVID-19 exposure (overcrowding, working outside the home, use of public transport to go to work) and prevention behaviours (use of face masks, washing hands, respect for physical distance) in France during the first wave of the epidemic.

Methods

We used the EpiCov population-based survey from a random sample of individuals aged 15 years or more. We determined the distribution of the self-reported outcomes according to migratory status and sex, using χ² tests. We modelled the probability of outcomes with logistic regression. Finally, we focused the analysis on the Greater Paris area and accounted for neighbourhood characteristics.

Results

A total of 111 824 participants were included in the study. Overall, immigrant groups from non-European countries were more exposed to COVID-19-related factors and more respectful of prevention measures. The probability of overcrowding and the use of public transport was higher for immigrants from sub-Saharan Africa [adjusted odds ratio (aOR) = 3.71 (3.19; 4.32), aOR = 6.36 (4.86; 8.32)] than for the majority population. Immigrant groups were less likely to have a non-systematic use of face masks and to breach physical distancing than the majority population [for immigrants from sub-Saharan Africa, aOR = 0.32 (0.28; 0.37) and aOR = 0.71 (0.61; 0.81), respectively]. Living in a neighbourhood with a higher share of immigrants was associated with higher exposure and better prevention behaviours.

Conclusions

In France, immigrants had a higher exposure to COVID-19-related factors and more systematic prevention behaviours.

Understanding Barriers and Facilitators to Compliance with UK Social Distancing Guidelines During the COVID-19 Pandemic: A Qualitative Interview Study

When followed, there is evidence that social distancing measures play a major role in reducing the transmission of viruses such as COVID-19. However, not all individuals follow the guidance. We explored barriers and facilitators to compliance with UK social distancing guidelines during the COVID-19 pandemic through semi-structured interviews with 116 adults. Data were analysed using reflexive thematic analysis and themes mapped to the Capability, Opportunity and Motivation Model of Behaviour (COM-B). Barriers to compliance included inconsistent rules, caring responsibilities, fatigue, unintended consequences of control measures, and the need for emotional support. Facilitators were informational support and social responsibility. Six themes were both a barrier and a facilitator: lived environment, beliefs about consequences of non-compliance, influence of others, practical support, and trust in government. Reflective motivation, psychological capability, and social opportunity were important drivers for compliance. Measures that enable social support alongside strategies to maintain motivation to comply, provide clear guidance and optimise social cohesion should be promoted.

Physicians' Compliance with COVID-19 Regulations: The Role of Emotions and Trust

(1) Background: Medical teams are at the forefront of the COVID-19 pandemic. Decision making among medical staff is important for promoting and maintaining the health of patients and staff. This study examines factors associated with physicians' decision making and preventive behavior during the COVID-19 pandemic in Israel. (2) Methods: An online survey was conducted among 187 Israeli physicians in April and May 2020 during the COVID-19 pandemic. The questionnaire included the levels of physicians' perceived threat and perceived risk during the epidemic, trust in the health system, emotions, and the degree of compliance with hygiene rules and mandated behaviors. (3) Results: Most physicians reported complying with the rules of hygiene at work (73%) and full compliance with Ministry of Health guidelines (61%). The findings show that higher levels of trust, positive emotions, and threat and risk perceptions were associated with a higher degree of compliance with Ministry of Health guidelines and more careful decision making among physicians. (4) Conclusions: Levels of trust in the health system and positive emotions among healthcare staff during the pandemic are related to careful adherence to guidelines. Taking steps to maintain physical and mental health among healthcare staff is important for their functioning and for maintaining public health.

Choosing between Homologous or Heterologous COVID-19 Vaccination Regimens: A Cross-Sectional Study among the General Population in Italy

A shortage of COVID-19 vaccines and reports of side-effects led several countries to recommend a heterologous regimen for second vaccine doses. This study aimed to describe the reasons behind individuals’ choices of a homologous or a heterologous second vaccination. This cross-sectional study enrolled individuals under 60 who had received a first dose of Vaxzevria and could choose between a homologous or heterologous regimen for their second dose. Quantitative (socio-demographic, clinical characteristics) and qualitative data were collected and analysed through a generalized linear model and thematic analysis, respectively. Of the 1437 individuals included in the analysis, the majority (76.1%) chose a heterologous second dose of the COVID-19 vaccination. More females chose a heterologous vaccination regimen (p = 0.003). Younger individuals also tended to choose heterologous vaccination (p < 0.001). The main motivation in favour of heterologous vaccination was to follow the Italian Ministry of Health recommendations (n = 118; 53.9%). This study showed that most individuals, mainly younger people and females, chose a heterologous dose of COVID-19 vaccination after their first viral vector vaccine. Heterologous vaccinations could be an effective public health measure to control the pandemic as they are a safe and efficient alternative to homologous regimens.

Adherence to Recommended Preventive Behaviors During the COVID-19 Pandemic: The Role of Empathy and Perceived Health Threat

Background

Coping via empathic responding may play a role in preventive behavior engagement during the COVID-19 pandemic, and unlike trait empathy, is a potentially alterable target for changing health behavior.

Purpose

Our goal was to examine the role of empathic responding in preventive behavior engagement during the COVID-19 pandemic, independent of trait empathy and perceived threat of COVID-19.

Methods

Participants (N = 2,841) completed a baseline survey early in the pandemic, and a follow-up survey approximately 2 weeks later (M = 13.50 days, SD = 5.61). Preventive health behaviors, including physical distancing and hygiene practices, were assessed at both timepoints. Hierarchical linear regression examined the contributions of trait empathy, perceived threat of COVID-19, and empathic responding at baseline to preventive behaviors at follow-up.

Results

Controlling for baseline levels of preventive behaviors and demographic covariates, trait empathy and threat of COVID-19 at baseline were each independently associated with preventive behaviors at follow-up. An interaction between perceived threat and empathic responding indicated that those perceiving high threat of COVID-19 at baseline tended to report engaging in preventive behaviors at follow-up regardless of their levels of empathic responding, whereas for those reporting low levels of perceived threat, higher levels of empathic responding were associated with higher engagement in preventive behavior.

Conclusions

When perceived threat of COVID-19 was low, higher empathic responding was associated with increased engagement in preventive behaviors regardless of trait empathy, suggesting that empathic responding can serve as an actionable target for intervention to promote preventive behavior during the pandemic.

Attitudes and Perceptions of Health Protection Measures Against the Spread of COVID-19 in Italy and Poland

Background: During the first wave of the COVID-19 pandemic (April to May 2020), 6,169 Polish and 939 Italian residents were surveyed with an online questionnaire investigating socio-demographic information and personality traits (first section) as well as attitudes, position, and efficacy perceptions on the impact of lockdown (second section) and various health protection measures enforced (third section). Methods: The "health protection attitude score" (HPAS), an endpoint obtained by pooling up the answers to questions of the third section of the survey tool, was investigated by multiple linear regression models, reporting regression coefficients (RC) with 95% confidence intervals (95% CI). Results: Concerns for business and health due to COVID-19 were associated with a positive attitude toward risk reduction rules. By contrast, male sex, concerns about the reliability of information available online on COVID-19 and its prevention, along with the feeling of not being enough informed on the transmissibility/prevention of SARS-CoV-2 were associated with a negative attitude toward risk mitigation measures. Discussion: A recent literature review identified two social patterns with different features in relation to their attitude toward health protection rules against the spread of COVID-19. Factors positively associated with adherence to public health guidelines were perceived threat of COVID-19, trust in government, female sex, and increasing age. Factors associated with decreased compliance were instead underestimation of the COVID-19 risk, limited knowledge of the pandemic, belief in conspiracy theories, and political conservativism. Very few studies have tested interventions to change attitudes or behaviors. Conclusion: To improve attitude and compliance toward risk reduction norms, a key intervention is fostering education and knowledge on COVID-19 health risk and prevention among the general population. However, information on COVID-19 epidemiology might be user-generated and contaminated by social media, which contributed to creating an infodemic around the disease. To prevent the negative impact of social media and to increase adherence to health protection, stronger content control by providers of social platforms is recommended.

A cross-sectional study of the relationship between delayed healthcare utilisation and chronic conditions among older adults during the COVID-19 pandemic in Ireland

Background: Many healthcare services were cancelled or postponed during the coronavirus 2019 (COVID-19) pandemic, likely impacting the management of chronic conditions prevalent among older adults in Ireland. Methods: Data from the Irish Longitudinal Study on Ageing COVID-19 study and previous waves were used. Taking healthcare demand into account, the relationship between delayed healthcare utilisation among older adults (≥50) with chronic conditions was examined. Further analyses examined the reasons for delays in healthcare utilisation, and whether they were the result of the reduced availability of healthcare services or participant decisions. Results: In total, 31.6% of participants reported experiencing healthcare delay. The first analysis found that older adults with two or more chronic conditions were more likely to have experienced healthcare delay than those with no chronic conditions (odds ratio (OR): 1.46, 95% confidence interval (CI): 1.11, 1.90). The second analysis found that older adults with two or more chronic conditions were more likely to have healthcare delayed by the provider (OR: 1.73, 95% CI: 1.16, 2.56), and were also more likely to delay their own healthcare (OR: 1.62, 95% CI: 1.14, 2.29) than older adults with no chronic conditions. Additionally, people aged 70 years and over, females, those with problematic alcohol consumption, those with third-level education, those who had visited the GP and those who reported polypharmacy were all more likely to experience healthcare delay, while older adults living with others and those living outside Dublin were less likely to experience healthcare delay. Conclusion: COVID-19 has had a significant impact on the healthcare utilisation of older adults in Ireland, with some groups of older adults impacted more than others. Policy and practice must now focus on how the healthcare needs of these groups can be best served. Further research is required to understand the impact of healthcare delays on health outcomes.

Factors That Shape People's Attitudes towards the COVID-19 Pandemic in Germany-The Influence of MEDIA, Politics and Personal Characteristics

Misinformation that accompanied the current SARS-CoV-2 pandemic led to an impaired risk perception, resulting in the refusal of personal protection measures, as well as a reduced willingness to receive a vaccination. In order to identify factors that might influence people's attitudes towards COVID-19 policies and engagement in mitigation measures, we carried out a cross-sectional study in Germany. Altogether, n = 808 participants completed our questionnaire concerning items on demographics, media consumption, risk perception, and trust in health authorities, as well as willingness to receive a vaccination. An overwhelming majority of our participants perceived SARS-CoV-2 as a health threat (85.7%), and almost two thirds (63.5%) mentioned they would get vaccinated against SARS-CoV-2 when a vaccination was available. A greater likelihood of vaccination intention was associated with being male (71.5% male vs. 60% female, p < 0.05), left-wing voting, trusting health authorities, using public media as an information source about COVID-19, and, in particular, perceiving COVID-19 as a health threat. A better understanding of factors that contribute to vaccine hesitancy is indispensable in order to eliminate doubts, increase vaccination rates, and create herd immunity, to stop further virus transmission.