The limitations of polling data in understanding public support for COVID-19 lockdown policies

Culture and effectiveness of distance restriction policies: evidence from the COVID-19 pandemic

Natural disasters bring indelible negative impacts to human beings, and people usually adopt some post hoc strategies to alleviate such impacts. However, the same strategies may have different effects in different countries (or regions), which is rarely paid attention by the academic community. In the context of COVID-19, we examine the effect of distance restriction policies (DRP) on reducing human mobility and thus inhibiting the spread of the virus. By establishing a multi-period difference-in-differences model to analyse the unique panel dataset constructed by 44 countries, we show that DRP does significantly reduce mobility, but the effectiveness varies from country to country. We built a moderating effect model to explain the differences from the cultural perspective and found that DRP can be more effective in reducing human mobility in countries with a lower indulgence index. The results remain robust when different sensitivity analyses are performed. Our conclusions call for governments to adapt their policies to the impact of disasters rather than copy each other.

Views about Euthanasia and Dementia: Exploring Perceptions Utilising Evidence from the Mass Observation Archive

This paper contributes to the ongoing discussion in the United Kingdom regarding euthanasia and assisted dying, using data specifically related to individuals with dementia. A qualitative approach was taken with data captured via a set of written questions in the form of a Mass Observation Archive Directive. The respondents, known as Observers, provided written responses; there was no limit to the length of the responses and the Observers were able to provide as much or as little detail as they chose. The data were analysed thematically utilising NVivo software. One-hundred and seven responses were received, representing a range of beliefs, and with opinions regarding euthanasia and dementia with pro, anti, and uncertain views being expressed. Five main themes emerged during our data analysis: capacity, legislation, agency and personal philosophies, disquietude, and incumbrance. Consistent with previous research capturing public views regarding euthanasia and assisted dying for people with dementia, the findings suggest policy makers may wish to consult the British public regarding legislation regarding euthanasia and dementia.

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.

The impact of "freedom day" on COVID-19 health protective behaviour in England: An observational study of hand hygiene, face covering use and physical distancing in public spaces pre and post the relaxing of restrictions

Objectives

To study the prevalence of COVID-19 health protective behaviours before and after rules eased in England on the 19^th July 2021.

Design

Observational study pre (12^th-18^th July) and post (26^th July-1^st August) 19^th July, and a cross-sectional online survey (26^th to 27^th July).

Setting

Observations occurred in supermarkets (n = 10), train stations (n = 10), bus stops (n = 10), a coach station (n = 1) and a London Underground station (n = 1). The survey recruited a nationally representative sample.

Participants

All adults entering the observed locations during a one-hour period (n = 3819 pre- and n = 2948 post-19^th July). In the online survey, 1472 respondents reported having been shopping for groceries/visited a pharmacy and 566 reported having used public transport or having been in a taxi/minicab in the last week.

Main outcome measures

We observed whether people wore a face covering, maintained distance from others and cleaned their hands. We investigated self-reports of wearing a face covering while in shops or using public transport.

Results

In most locations observed, the proportion of people wearing face coverings, cleaning the hands and maintaining physical distance declined post 19th July. Pre 19^th July, 70.2% (95% CI 68.7 to 71.7%) of people were observed to be wearing a face covering versus 55.8% (54.2 to 57.9%) post 19^th July. Equivalent rates for physical distancing were 40.9% (39.0 to 42.8%) versus 29.5% (27.4 to 31.7%), and for hand hygiene were 4.4% (3.8 to 5.1%) versus 3.9% (3.2 to 4.6%). Self-reports of "always" wearing face coverings were broadly similar to observed rates.

Conclusions

Adherence to protective behaviours was sub-optimal and declined during the relaxation of restrictions, despite appeals to exercise caution. Self-reports of "always" wearing a face covering in specific locations appear valid.

Neuroticism predicts national vaccination rates across 56 countries

Quite strikingly, there is significant variation in Covid-19 vaccine coverage around the world. Some countries do not progress from around 2-3% while others are close to 100% coverage. In addition to some already known economic, health and sociodemographic predictors, the present research is interested in emotional factors that may predict a significant part of this cross-country variation. We examined the personality factor Neuroticism, which corresponds to the relatively stable tendency to experience negative emotions, anxiety and low tolerance for stress. Results confirm that gross domestic product represents around 50 percent of cross-country variation. Neuroticism added 6 to 9 percent of inter-country variation in vaccination coverage. The results are discussed in relation to the associations between Neuroticism, increased worry, greater attention to Covid-19 related information and confidence, as well as lower vaccine hesitancy.

Understanding public support for COVID-19 pandemic mitigation measures over time: Does it wear out?

Background

COVID-19 mitigation measures intend to protect public health, but their adverse psychological, social, and economic effects weaken public support. Less favorable trade-offs may especially weaken support for more restrictive measures. Support for mitigation measures may also differ between population subgroups who experience different benefits and costs, and decrease over time, a phenomenon termed "pandemic fatigue."

Methods

We examined self-reported support for COVID-19 mitigation measures in the Netherlands over 12 consecutives waves of data collection between April 2020 and May 2021 in an open population cohort study. Participants were recruited through community panels of the 25 regional public health services, and through links to the online surveys advertised on social media. The 54,010 unique participants in the cohort study on average participated in 4 waves of data collection. Most participants were female (65%), middle-aged [57% (40-69 years)], highly educated (57%), not living alone (84%), residing in an urban area (60%), and born in the Netherlands (95%).

Results

COVID-19 mitigation measures implemented in the Netherlands remained generally well-supported over time [all scores >3 on 5-point scale ranging 1 (low)-5 (high)]. During the whole period studied, support was highest for personal hygiene measures, quarantine and wearing face masks, high but somewhat lower for not shaking hands, testing and self-isolation, and restricting social contacts, and lowest for limiting visitors at home, and not traveling abroad. Women and higher educated people were more supportive of some mitigation measures than men and lower educated people. Older people were more supportive of more restrictive measures than younger people, and support for more socially restrictive measures decreased most over time in higher educated people or in younger people.

Conclusions

This study found no support for pandemic fatigue in terms of a gradual decline in support for all mitigation measures in the first year of the pandemic. Rather, findings suggest that support for mitigation measures reflects a balancing of benefits and cost, which may change over time, and differ between measures and population subgroups.

Has the COVID-19 pandemic strengthened confidence in managing the climate crisis? Transfer of efficacy beliefs after experiencing lockdowns in Switzerland and Austria

In the spring of 2020, countries introduced lockdowns as radical measures to deal with the first wave of the COVID-19 pandemic, which led to strong disruptions of people's everyday lives. Such drastic collective measures had previously seemed inconceivable in relation to other urgent crises, such as the climate crisis. In this paper, we ask how individual, participatory, and collective efficacy beliefs in dealing with the COVID-19 pandemic transferred to efficacy beliefs regarding the climate crisis. We present comparative results from two surveys: Study 1 assesses efficacy beliefs among German-speaking Swiss residents (n = 1,016), shortly after lockdown measures were relaxed. Study 2 compares changes in efficacy beliefs among Austrian high school students (n = 113) before and after the lockdown. In Study 1, climate-related self- and participatory efficacy are enhanced by the corresponding COVID-19-related beliefs. Climate-related efficacy beliefs mediate the effect of COVID-related counterparts on climate-friendly behavior and policy support. Study 2 shows that COVID-19-related efficacy beliefs are transferred to climate-related counterparts over time, and that the transfer of participatory efficacy is moderated by perceived similarity of the two crises. Experiencing successful individual and collective action during the COVID-19 pandemic seems to inspire confidence in dealing with climate change. Underlying processes (direct transfer, consistency, awareness-raising, learning) are discussed.

Patterns of social mixing in England changed in line with restrictions during the COVID-19 pandemic (September 2020 to April 2022)

Social mixing contributes to the transmission of SARS-CoV-2. We developed a composite measure for risky social mixing, investigating changes during the pandemic and factors associated with risky mixing. Forty-five waves of online cross-sectional surveys were used (n = 78,917 responses; 14 September 2020 to 13 April 2022). We investigated socio-demographic, contextual and psychological factors associated with engaging in highest risk social mixing in England at seven timepoints. Patterns of social mixing varied over time, broadly in line with changes in restrictions. Engaging in highest risk social mixing was associated with being younger, less worried about COVID-19, perceiving a lower risk of COVID-19, perceiving COVID-19 to be a less severe illness, thinking the risks of COVID-19 were being exaggerated, not agreeing that one’s personal behaviour had an impact on how COVID-19 spreads, and not agreeing that information from the UK Government about COVID-19 can be trusted. Our composite measure for risky social mixing varied in line with restrictions in place at the time of data collection, providing some validation of the measure. While messages targeting psychological factors may reduce higher risk social mixing, achieving a large change in risky social mixing in a short space of time may necessitate a reimposition of restrictions.

Exploring the awareness, attitudes, and actions (AAA) of UK adults at high risk of severe illness from COVID-19

Background

People at high risk of severe illness from COVID-19 have experienced greater restrictions during the pandemic, yet there is a paucity of research exploring their lived experience.

Objectives

This study explored the impact of COVID-19 on people identified as at high risk of severe illness by UK Government, and in particular, the impact of the first lockdown on access to healthcare, medications and use of technological platforms.

Methods

1038 UK adults who identified as at high risk of severe illness from COVID-19 in line with UK Government guidance or self-identified with acute or other chronic health conditions, completed the Awareness, Attitudes and Actions survey which explored the impact of COVID-19 on access to healthcare, management of long-term health condition, mental health, and health behaviours.

Results

Most participants reported feelings of vulnerability, anxiety and isolation, noticed that other people changed their behaviour towards them including a feeling of being stigmatised by people not categorised as high risk. Participants described the largely negative impact that the COVID-19 lockdown had on to health-related behaviours and access to healthcare, which had resulted in large declines in mental health and wellbeing. Participants also indicated disappointment at the UK Governments response and handling of the COVID-19 lockdown.

Implications

This study provides novel evidence of the lived experience of the first COVID-19 lockdown for people identified as at high risk of severe illness. In the context of behavioural health interventions, the ubiquity of digital technologies and their adoption into day-to-day life translates into greater potential reach than traditional interventions, and consequently, greater potential for positive public health impact. Findings should be considered by policymakers and healthcare professionals to support people now and as we transition through the recovery phase with a particular emphasis on supporting mental health and changes to the management of long-term health conditions.

The limitations of polling data in understanding public support for COVID-19 lockdown policies

Opinion polls regarding policies designed to tackle COVID-19 have shown public support has remained high throughout the first year of the pandemic in most places around the world. However, there is a risk that headline support over-simplifies people's views. We carried out a two-wave survey with six-month interval on a public sample (N = 212) in the UK, examining the factors that underpin lockdown policy support. We find that the majority of people support most public health measures introduced, but that they also see significant side effects of these policies, and that they consider many of these side effects as unacceptable in a cost-benefit analysis. We also find that people judged the threat of COVID-19 via the magnitude of the policy response, and that they do not use their perception of the personal threat to themselves or close others to guide their support for policy. Polling data only offer one simple perspective and do not illustrate the ambivalence many people feel around lockdown policies. There is also a meaningful risk of public opinion and government policy forming a symbiotic relationship, which impacts upon how effectively such policies are implemented both now, and in relation to future threats.