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

Factors associated with the COVID-19 booster vaccine intentions of young adults in the United States

Young adults experience high coronavirus disease 2019 (COVID-19) incidence yet have the lowest vaccination and booster rates among adults. Understanding the factors influencing their intentions regarding boosters is essential for crafting effective public health strategies. We examined the psychosocial factors (attitudes, norms, perceived behavioral control) associated with their intentions to receive a COVID-19 booster. This cross-sectional study included 292 young adults aged 18-25 residing in Philadelphia who completed an online survey from September 2021 and February 2022 (mean age 21.98, standard deviation 2.25; 51% racial/ethnic minorities). The survey included measures of attitudes, norms, and perceived behavioral control related to COVID-19 vaccination. We employed structural equation modeling analysis to examine the intention of young adults to receive the COVID-19 booster and their vaccine-related attitudes, norms, and perceived behavioral control. Covariates included race/ethnicity and gender. Subjective norms were significantly associated with the intention to receive a COVID-19 booster (standardized β̂ = 0.685, p = .018). Attitudes and perceived behavioral control showed no significant association with intention. Subgroup analyses based on race/ethnicity revealed that attitudes (standardized β̂ = 0.488, p = .004) and subjective norms (standardized β̂ = 0.451, p = .050) were predictors among young adults from racial and ethnic minority backgrounds, while only subjective norms (standardized β̂ = 1.104, p = .002) were significant for non-Hispanic White young adults. Public health efforts should prioritize engaging healthcare providers and peer groups in order to influence subjective norms and promote collective responsibility and acceptance for vaccination. Tailored interventions and diverse communication strategies targeting specific subgroups of young adults may be useful to ensure comprehensive and effective vaccination initiatives.

Predictors of fear of COVID-19 in a low-income country: health literacy is important

Introduction

Excessive fear of a threatening condition or situation can result in individuals engaging in unhealthy behaviors, especially during the COVID-19 pandemic. Identifying the influential factors of fear can be effective in designing and implementing health-center interventions to control and reduce the COVID-19 pandemic.

Methods

This study was a cross-sectional design implemented in Iran in 2022. Participants were adults 18-65 years of age recruited randomly from primary Health Care Services Centers (HCSCs) by medical records (n = 380, 64.7% female, mean (SD) age 32.14 ± 10.98 years) in urban and rural areas of the county. The data collection included a demographic form, Fear of COVID-19 questionnaire, Perceived Barriers of COVID-19 preventive behaviors, Self-efficacy, and Health Literacy for Iranian Adults (HELIA) questionnaire.

Results

It was determined that the fear of COVID-19 showed statistically significant differences according to gender (p-value = 0.013), education level (p-value = 0.001), and job status (p-value = 0.001). According to the hierarchical linear regression, educational level (p-value = 0.001; β = 0.665), job (β = 0.126; p-value = 0.018), self-efficacy (p-value = 0.015; β = 0.103), and Health Literacy (HL) (p-value = 0.001; β = 0.446) were significant predictors of fear of COVID-19. Also, among variables, educational level (p-value = 0.001; β = 0.665) and HL (p-value = 0.001; β = 0.446) were the most important predictors for fear of COVID-19.

Discussion

This research shows that HL has a potential and determinative role in controlling fear of COVID-19. The findings can help healthy policymakers and healthcare providers design HL-based programs in similar epidemics and pandemic situations.

Managing Fear During Pandemics: Risks and Opportunities

Fear is an emotion triggered by the perception of danger and motivates safety behaviors. Within the context of the COVID-19 pandemic, there were ample danger cues (e.g., images of patients on ventilators) and a high need for people to use appropriate safety behaviors (e.g., social distancing). Given this central role of fear within the context of a pandemic, it is important to review some of the emerging findings and lessons learned during the COVID-19 pandemic and their implications for managing fear. We highlight factors that determine fear (i.e., proximity, predictability, and controllability) and review several adaptive and maladaptive consequences of fear of COVID-19 (e.g., following governmental health policies and panic buying). Finally, we provide directions for future research and make policy recommendations that can promote adequate health behaviors and limit the negative consequences of fear during pandemics.

Mental health and the overall tendency to follow official recommendations against COVID-19: A U-shaped relationship?

This paper investigates the association between several mental health indicators (depression, anxiety, stress, and loneliness) and the overall tendency to follow official recommendations regarding self-protection against COVID-19 (i.e., overall compliance). We employ panel data from the COME-HERE survey, collected over four waves, on 7,766 individuals (22,878 observations) from France, Germany, Italy, Spain, and Sweden. Employing a flexible specification that allows the association to be non-monotonic, we find a U-shaped relationship, in which transitions to low and high levels of mental health are associated with higher overall compliance, while transitions to medium levels of mental health are associated with less overall compliance. Moreover, anxiety, stress, and loneliness levels at baseline (i.e., at wave 1) also have a U-shaped effect on overall compliance later (i.e., recommendations are followed best by those with lowest and highest levels of anxiety, stress, and loneliness at baseline, while following the recommendations is lowest for those with moderate levels of these variables). These U shapes, which are robust to several specifications, may explain some of the ambiguous results reported in the previous literature. Additionally, we observe a U-shaped association between the mental health indicators and a number of specific health behaviours (including washing hands and mask wearing). Importantly, most of these specific behaviours play a role in overall compliance. Finally, we uncover the role of gender composition effects in some of the results. While variations in depression and stress are negatively associated with variations in overall compliance for men, the association is positive for women. The U-shaped relation in the full sample (composed of males and females) will reflect first the negative slope for males and then the positive slope for females.

The vaccination divide: Exploring moral reasoning associated with intergroup antipathy between vaccinated and unvaccinated people

OBJECTIVES

There is growing evidence of intergroup hostility between vaccinated and unvaccinated individuals, a process of polarization that threatens to derail population health efforts. This study explores the moral underpinnings of intergroup antipathy between vaccinated and unvaccinated individuals.

DESIGN

A cross-sectional design was employed to investigate the associations between the view of vaccination as a social contract or individual choice, perceived vulnerability to disease, perceptions of outgroup morality, feelings of warmth, and experiences of schadenfreude.

METHODS

Data were extracted from an online, quantitative survey of 233 vaccinated and 237 unvaccinated participants collected between June and July 2022.

RESULTS

Results revealed that vaccinated people had stronger negative attitudes towards unvaccinated people than vice versa. In line with hypotheses, the extent to which vaccinated people saw vaccination as a social contract was significantly associated with perceiving unvaccinated people as immoral. For unvaccinated people, seeing vaccination as an individual choice (the opposite of a social contract) was significantly associated with perceiving vaccinated people as immoral. Among both groups, viewing the other as immoral was associated with feeling significantly less warmth towards the opposing vaccination group, and more schadenfreude in the face of an outgroup member's suffering. Participants' perceived vulnerability to disease played a relatively small role in explaining polarization between vaccinated and unvaccinated people.

CONCLUSIONS

This research builds on previous studies by identifying moral mechanisms associated with intergroup antipathy in the vaccine debate.

Motivating Protective Behavior against COVID-19: Fear Versus Hope

OBJECTIVES

Based on protection motivation theory, we investigate how indicators of threat perception (perceived severity, perceived vulnerability, and fear arousal) and coping appraisal (hope) are associated with older people's motivation to engage in protective behavior after the outbreak of COVID-19.

METHODS

We use multivariate regression analyses with a sample of 40,282 individuals from 26 countries participating in the SHARE Corona Survey.

RESULTS

We find that 15% of all respondents stayed home completely-mainly the oldest and vulnerable people with prior health risk conditions. On average, older Europeans responded strongly to the recommended protective behavior measures (6 out of 7 measures adopted). Among the threat perception indicators, fear arousal is the main motivator for protective behavior, whereas the coping appraisal indicator hope shows an equally strong association.

DISCUSSION

Given the negative health effects of fear, our findings may help evaluate and revise governmental policy responses and communication strategies.

A practical agenda for incorporating trust into pandemic preparedness and response

Despite widespread acknowledgement that trust is important in a pandemic, few concrete proposals exist on how to incorporate trust into preparing for the next health crisis. One reason is that building trust is rightly perceived as slow and challenging. Although trust in public institutions and one another is essential in preparing for a pandemic, countries should plan for the possibility that efforts to instil or restore trust may fail. Incorporating trust into pandemic preparedness means acknowledging that polarization, partisanship and misinformation may persist and engaging with communities as they currently are, not as we would wish them to be. This paper presents a practical policy agenda for incorporating mistrust as a risk factor in pandemic preparedness and response planning. We propose two sets of evidence-based strategies: (i) strategies for ensuring the trust that already exists in a community is sustained during a crisis, such as mitigating pandemic fatigue by health interventions and honest and transparent sense-making communication; and (ii) strategies for promoting cooperation in communities where people mistrust their governments and neighbours, sometimes for legitimate, historical reasons. Where there is mistrust, pandemic preparedness and responses must rely less on coercion and more on tailoring local policies and building partnerships with community institutions and leaders to help people overcome difficulties they encounter in cooperating with public health guidance. The regular monitoring of interpersonal and government trust at national and local levels is a way of enabling this context-specific pandemic preparedness and response planning.

"Oh no, they caught it!": Vicarious experience of COVID-19, protection motivation and protective behaviors

Utilizing the components of the protection motivation theory, this study investigated the role of close others' diagnosis of COVID-19 (as a vicarious experience) in individuals' adherence to protective behavior against COVID-19. Path analysis of online survey data from 3695 participants showed that the presence of a diagnosed close other was positively related to perceived vulnerability, while being negatively related to perceived response efficacy and self-efficacy. In addition, perceived severity and efficacy appraisals were positively associated with protective behavioral tendencies. Although efficacy appraisal mediated the relationship between vicarious experience and protective behavior, threat appraisal did not mediate this relationship. In sum, the results suggest that efficacy appraisal derived from vicarious experiences can be more consequential for protective behaviors than threat appraisal. Implications of these results on future large-scale health crises are discussed along with limitations and future directions.

The role of trust, vaccine information exposure, and Health Belief Model variables in COVID-19 vaccination intentions: Evidence from an HBCU sample

African Americans have been disproportionately affected by COVID-19 and COVID-19 vaccines were initially met with hesitancy from the African American community. This study identified predictors of COVID-19 vaccination intentions among students attending a Historically Black College and University (HBCU) when COVID-19 vaccines first became available. Unvaccinated students (N = 224) completed a survey. Path analysis modeled relationships among exogenous variables (trust, exposure to pro- and anti-vaccine information), proposed mediators (Health Belief Model variables), and COVID-19 vaccination intentions. Students reported low trust in government officials, medical professionals, and the vaccine development process. Direct predictors of vaccination intentions included trust, perceived benefits, and perceived barriers. Students with lower trust reported lower benefits, increased concerns about side effects, and were more likely to view COVID-19 vaccination as low priority, and these factors in turn predicted intentions. Findings highlight the urgent need for theory-driven, culturally sensitive, age-relevant messaging to reduce vaccine hesitancy among Black young adults.

Compliance in the public versus the private realm: Economic preferences, institutional trust and COVID-19 health behaviors

To what extent do economic preferences and institutional trust predict compliance with physical distancing rules during the COVID-19 pandemic? We reexamine this question by introducing the theoretical and empirical distinction between individual health behaviors in the public and in the private domain (e.g., keeping a distance from strangers vs. abstaining from private gatherings with friends). Using structural equation modeling to analyze survey data from Germany's second wave of the pandemic (N = 3350), we reveal the following major differences between compliance in both domains: Social preferences, especially (positive) reciprocity, play an essential role in predicting compliance in the public domain but are barely relevant in the private domain. Conversely, individuals' degree of trust in the national government matters predominantly for increasing compliance in the private domain. The clearly strongest predictor in this domain is the perception pandemic-related threats. Our findings encourage tailoring communication strategies to either domain-specific circumstances or factors common across domains. Tailored communication may also help promote compliance with other health-related regulatory policies beyond COVID-19.

Exploring the impact of pandemic fear on visitation to park attractions in urban city: A case study in Seoul, South Korea

This research explores changes in perceptions and utilization of parks during the COVID-19 pandemic in Seoul, South Korea. It investigates the relationship between fear of the pandemic and individuals' opinions about open spaces and their visiting decisions. The study surveyed 600 adults from February 22-23, 2022, and used structural equation modeling to analyze the data. The findings revealed that increased fear of the pandemic led to more positive park sentiments, resulting in higher park visits and fewer visits to other public spaces. The research highlights the significance of parks during the COVID-19 pandemic and how people's perceptions were influenced by their pandemic-related fear.

Coping during COVID-19: how attitudinal, efficacy, and personality differences drive adherence to protective measures

INTRODUCTION

COVID-19 has had a devastating impact on people's lives since its initial outbreak and global spread in 2020. While the U.S. government and public health officials have recommended best practices such as social distancing, wearing a mask, and avoiding large public gatherings, these orders have been met with varying levels of acceptance from the public. Given the disparate compliance, this study builds on Social Cognitive Theory (SCT) to explore individual differences and personal motivation factors in order to better understand what may influence one's likelihood to adhere to COVID-19 protective measures.

METHODS

A U.S. national survey (N = 2,049) was conducted April-May 2020, roughly one month after stay-at-home orders were issued in some states. Participants were asked to report their likelihood of taking individual and community protective measures. Multivariate hierarchical linear regressions were run to analyze the extent to which participants' concerns about COVID-19's impact, individual and collective self-efficacy, coping behaviors, and personality traits influenced the dependent variables.

RESULTS

Findings showed that COVID-19-related health concerns, collective efficacy, and proactive coping strategies were positively related to participants' likelihood of taking protective measures. Those with greater concerns about their general well-being and the economy, adverse coping strategies like denial and joking, as well as sensation-seeking personalities, were less likely to take protective measures.

CONCLUSION

The discussion considers how individual differences fit into broader global efforts to stem COVID-19. Practical implications for public health messaging are that communication may focus on facilitating efficacy in order to boost compliance with protective measures.

Behavioural Sciences Contribution to Suppressing Transmission of Covid-19 in the UK: A Systematic Literature Review

BACKGROUND

Governments have relied on their citizens to adhere to a variety of transmission-reducing behaviours (TRBs) to suppress the Covid-19 pandemic. Understanding the psychological and sociodemographic predictors of adherence to TRBs will be heavily influenced by the particular theories used by researchers. This review aims to identify the theories and theoretical constructs used to understand adherence to TRBs during the pandemic within the UK social and legislative context.

METHODS

A systematic review identified studies to understand TRBs of adults in the UK during the pandemic. Identified theoretical constructs were coded to the Theoretical Domains Framework. Data are presented as a narrative summary.

RESULTS

Thirty-five studies (n = 211,209) investigated 123 TRBs, applied 13 theoretical frameworks and reported 50 sociodemographic characteristics and 129 psychological constructs. Most studies used social cognition theories to understand TRBs and employed cross-sectional designs. Risk of sampling bias was high. Relationships between constructs and TRBs varied, but in general, beliefs about the disease (e.g. severity and risk perception) and about TRBs (e.g. behavioural norms) influenced behavioural intentions and self-reported adherence. More studies than not found that older people and females were more adherent.

CONCLUSIONS

Behavioural scientists in the UK generated a significant and varied body of work to understand TRBs during the pandemic. However, more use of theories that do not rely on deliberative processes to effect behaviour change and study designs better able to support causal inferences should be used in future to inform public health policy and practice.

PROSPERO REGISTRATION

CRD42021282699.

Compliance with World Health Organization COVID-19 preventive behaviors in rural counties in Western Kenya: a cross-sectional study

Introduction

the World Health Organization (WHO) recommended various measures to tackle COVID-19, and were adopted by many governments, targeting behavior change among citizens to lower the transmission. There was a paucity of data on the patterns of compliance with different measures within individuals and whether people adhere to all recommended measures or cautiously prefer few but not others. Understanding compliance behaviors and associated factors is important for developing interventions to increase compliance.

Methods

cross-sectional study was conducted among adults in the western region of Kenya. A sample of 806 participants was selected using a stratified sampling method. A structured questionnaire was used to gather data from the participants. Compliance was assessed with six behaviors: hand sanitation, proper hygiene, no handshaking, social distancing, and other guidelines. Latent analysis was used to identify behavioral patterns. Descriptive statistics were used to assess demographic characteristics, in terms of frequency distribution, and percentages. Multinomial logistic regression was used to assess the association between demographic characteristics and compliance level.

Results

compliance was highest for masking (85.3%), and was lowest for social distancing (60.2%). The majority of participants were found to be full compliers (class 1: 40.5%), there was an increased probability of full compliance among those aged between 18-30 years (OR= 1.042; 95% CI: 0.307-13.052, p < 0.040) compared to those aged ≥70.

Conclusion

using facemasks had the highest rate of compliance, followed by hand sanitization and proper hygiene. However, overall, the findings showed that while compliance with some protocol behaviors is high, individuals comply consistently across recommended compliance behaviors.

The development of compliance behavioral imperatives in public for management of covid-19

The Covid-19 pandemic, which was declared a public health emergency on 30 January 2020, has made it crucial for humans to learn how to behave to control the pandemic's spread. Policymakers must assess human behaviour and their responses to pandemic breakouts to develop a strategy for limiting pandemics and their harm to society at large. The present study applying exploratory factor analysis assessed five aspects of human behaviour regarding Covid-19, namely compliance behaviour, avoidance behaviour, protective behaviour, informed behaviour, and risk perception. The study applying hierarchical regression discovered that by combining informed, protective, and avoidance behaviour, people can be convinced to embrace the compliance behaviour required by public authorities. Furthermore, higher risk perception also positively moderates the relationship between information and compliance behaviour.

Mediating factors explain anxiety experienced by women with obesity during the Covid-19 pandemic

The Covid-19 pandemic could be a source of great anxiety, especially for those at higher risk, such as women experiencing obesity. The aim of this study was to measure how some personal characteristics such as BMI (from underweight to class 3 obesity), bariatric surgery (yes or no), comorbidities, or age (as antecedent variables), and mediating factors impacted state anxiety during the Covid-19 Pandemic. Mediating factors were related to subjective knowledge or attitudes (e.g. interest or beliefs and practices around Covid-19, subjective health perception, and confidence in the government). French women (N = 532) were invited to take part in a voluntary online health survey during lockdown in Paris and its suburbs. Results showed that women with higher BMI had higher anxiety scores, primarily because they feel less healthy than other people. Secondly, the larger the body size of the participants was (BMI), the less they reported that information about Covid-19 held their attention. This lack of interest resulted in feelings of anxiety not being generated. Thirdly, the larger their body size was, the less confidence they had in the effectiveness of the proposed measures by the government and therefore, the more anxious they were. Finally, older age predicted higher interest in the pandemic, higher subjective health, and higher confidence in the government. Identifying obesity as a potential risk factor for anxiety disorders is crucial, but measuring the relationship between state anxiety and personal characteristics (e.g. BMI) requires considering mediating variables (e.g. subjective health perception). To reduce anxiety in women with obesity, it appears necessary to focus on psychological programs that can help them improve their perception of their health, as well as the confidence they may have in institutions, especially for younger women.

Factors Associated With Levels of Public Engagement in Protective Behaviors During the Early COVID-19 Pandemic: Causal-Comparative Study Based on the Health Belief Model

BACKGROUND

While the challenges of COVID-19 are still unfolding, the enhancement of protective behavior remains a top priority in global health care. However, current behavior-promoting strategies may be inefficient without first identifying the individuals with lower engagement in protective behavior and the associating factors.

OBJECTIVE

This study aimed to identify individuals with and potential contributing factors to low engagement in protective behavior during the COVID-19 pandemic.

METHODS

This is a causal-comparative study. A theory-based web-based survey was used to investigate individuals' protective behavior and potential associating factors. During June 2020, the distribution of the survey was targeted to 3 areas: Taiwan, Japan, and North America. Based on the theory of the health belief model (HBM), the survey collected participants' various perceptions toward COVID-19 and a collection of protective behaviors. In addition to the descriptive analysis, cluster analysis, ANOVA, and Fisher exact and chi-square tests were used.

RESULTS

A total of 384 responses were analyzed. More than half of the respondents lived in Taiwan, followed by Japan, then North America. The respondents were grouped into 3 clusters according to their engagement level in all protective behaviors. These 3 clusters were significantly different from each other in terms of the participants' sex, residency, perceived barriers, self-efficacy, and cues of action.

CONCLUSIONS

This study used an HBM-based questionnaire to assess protective behaviors against COVID-19 and the associated factors across multiple countries. The findings indicate significant differences in various HBM concepts among individuals with varying levels of behavioral engagement.

Third- and First-Person Effects of COVID News in HBCU Students' Risk Perception and Behavioral Intention: Social Desirability, Social Distance, and Social Identity

With COVID-19's unprecedented impact and ongoing debates on prosocial social distancing and antisocial beach crowd gathering, this study examined the roles of social desirability, social distance marked by race, and social identity in the third-person effect (TPE) of COVID-related news concerning risk perception among Historically Black College and University (HBCU) students. The findings confirmed third- and first-person effects with the perceived influence of antisocial (beach partying) news greater for others than themselves, whereas the self was perceived to be more responsive to the influence of prosocial (social distancing) news. A symmetric interaction between social desirability and social identity indicated that the racial out-group, non-HBCU students in Florida were perceived as more affected by antisocial beach party news, whereas the in-group HBCU peers were perceived as more influenced by desirable social distancing warning news and COVID news in general. The first-person perception and shrunk self-other gap in COVID news influence on HBCU students" concerns may be associated with perceived personal vulnerability and responsibility as well as a political reflection on the government's handling of COVID. While they presumed favorable media influence on self and the in-group to preserve collective self-esteem, they made realistic threat judgments from perceiving undesirable media influence on their in-group peers' risky behavior tendency and intended to take preventive actions (staying home) to avoid the health risk. Further, it was the first-person perceptual gap between themselves and the out-group, non-HBCU students that influenced them to heed social distancing warnings.

Exploring the perceptions and lived experiences of family members living with people diagnosed with COVID-19 in South Africa: a descriptive phenomenological study

BACKGROUND

The incidence and prevalence of COVID-19 continues to escalate globally, with the consequence to quality of life, the economies of nations and various sectors of society. While there is substantial research on the impact and experiences of the COVID-19 pandemic, little remains known about the perceptions and lived experiences of families living with people diagnosed with COVID-19, particularly within the South African context.

PURPOSE

To explore the perceptions and lived experiences of family members  living with people diagnosed with COVID-19 in South Africa.

METHODS

A descriptive phenomenological design was used. Data were collected from 15 participants who were family members of people diagnosed with COVID-19 in South Africa. Purposive snowball sampling was used to identify and recruit participants, and data were collected at community level in KwaZulu-Natal, Western Cape and Gauteng, South Africa. Individual in-depth interviews were used to collect the data, and an audio tape was used to record all interviews. Data were transcribed verbatim and analysed using a phenomenological data analysis processes. Ethical approval to conduct the study was obtained from the University of KwaZulu-Natal Research Ethics Committee-reference number: BREC00003228/2021.

RESULTS

Four super-ordinate themes emerged in relation to the perceptions and lived experiences of family members  living with people diagnosed with COVID-19 in South Africa. The superordinate themes were: (1) sources of information about COVID-19, (2) pandemic  perceptions and experiences, (3) impact of diagnosis and related burden and (4) aftermath of living with a family member diagnosed with COVID-19.

DISCUSSION AND CONCLUSION

Family members' perceptions and lived experiences of COVID-19 are largely influenced by media, moreover, the impact of diagnosis has consequences for the physical, mental and emotional well-being of family members. Diagnosis disrupts family dynamics by depleting financial resources due to  the caregiver burden experienced. The findings thus imply that provision of psychosocial support is imperative for families living with persons diagnosed with COVID-19.

Path Model Analysis of the Effects of Perceived Formalism, and Fear of COVID-19 on Police Officers' PTSD and Insomnia

This study examines whether law enforcement officers' fear of COVID-19, job burnout, and job stress have increased their PTSD and insomnia during the epidemic. This article introduces the perceived formalism of police agencies into the causal model to explore whether perceived formalism increases the job burnout and job stress of police officers. The formalism of administrative agencies is rarely included in epidemic research. This study collected 306 Taiwanese police officers as research subjects. We used confirmatory factor analysis and SEM for hypothesis testing. The study found that perceived formalism positively affects the job burnout and job stress of police officers. Job stress, fear of COVID-19, and job burnout positively affect PTSD and insomnia.

A qualitative study examining young peoples' perceptions and adherence to COVID-19 public health guidelines in Ireland

BACKGROUND

Public health measures are the main intervention to stop the spread of COVID-19. They rely on the adherence to everyday health behaviors, and depend on those at high and low personal risk of serious disease to comply. Young people are crucial to stemming community transmission, and are often living in shared housing and at a stage of their lives with more economic uncertainty than older groups. Public health messaging has relied on the mantra that we are 'in it together,' despite very diverse experiences of the pandemic across different groups. The central aim of this research is to understand and optimize young peoples' engagement with public health guidelines with the view to improve future adherence with public health initiatives.

METHOD

Twelve young people were interviewed as part of this research, ranging from 18 to 24 years. Interviewees were chosen to ensure that there was a diverse range of opinions within the participant pool. Interviews were semi-structured with open questions and the flexibility to explore the topics of interest that arose. All interviews were fully transcribed and analyzed using thematic analysis.

RESULTS

This study found that participants deemed the consequences of lockdown a greater threat than infection with SARS-COV-2. Participants expressed concerns about the government's handling of the pandemic. Some felt young peoples' interests were not represented by authorities. There were concerns that messaging was inaccurate, difficult to understand, and filled with statistical and medical jargon. These perceptions underpinned a sense that the guidelines could be broken in good conscience as well as result in accidental breaches of the guidelines. Though wider community factors were often cited as having a positive influence on health behavior, differences and division were seen to inspire trust or adherence.

CONCLUSION

These findings provide an insight into the psychological, financial and physical difficulties young people face as a consequence of pandemic public health measures and lockdowns in particular. They highlight the need for better communication with young people to support and embed trust in authorities and the scientific and political community.

One year of COVID-19 in dental health services in Norway: psychological impact, risk perceptions and vaccination status

BACKGROUND

Increased psychological pressure on oral healthcare professionals (OHP) due to COVID-19 has been shown, yet little is known about the long-term psychological impacts. We aimed to study the psychological impact of COVID-19 and associated factors including perceived risk and preparedness and vaccination status among OHP in the first year after the lockdown period in Norway.

METHODS

A structured questionnaire sent electronically to dentists, dental hygienists and dental assistants inquired experiences and perceptions during the second year following the outbreak in Norway. The questionnaire comprised a COVID-19 fear scale and questions about risk perception, preparedness and vaccination status. Exploratory factor analysis (EFA) and Structural Equation Modeling (SEM) were used to assess psychological impact, perception of risk and preparedness according to vaccination status of the respondents.

RESULTS

The majority of the 708 respondents were female (92.8%), had ten or more years of work experience (67.1%), and worked in public dental clinics (95.9%). Fears and concerns related to COVID-19 were common, 72.6% feared getting infected and 85.4% feared infecting others. Of the 642 respondents who agreed that their workplaces handled the situation well, 55.6% were fully vaccinated. Three factors were retrieved from EFA: Insecurity, Instability and Infection. SEM showed that females were more concerned with Infection, and respondents with long clinical experience were less likely to express fear about Instability. Fully vaccinated individuals felt more insecure about becoming infected, and those agreeing that their workplaces handled the current situation well were concerned with Insecurity.

CONCLUSIONS

Despite widespread perception of adequate preparedness and high vaccine coverage, a considerable psychological impact and high levels of fear of COVID-19 were observed among the majority of OHP. Fully vaccinated individuals had a larger psychological burden than not fully vaccinated and those with unknown vaccination status. These findings can inform means and interventions to reduce negative impacts of fear in populations with a high psychological burden.

Acceptability of restrictions in the COVID-19 pandemic: a population-based survey in Denmark and Sweden

Introduction

Denmark and Sweden initially adopted different responses to the COVID-19 pandemic although the two countries share many characteristics. Denmark responded swiftly with many mandatory restrictions. In contrast, Sweden relied on voluntary restrictions and a more "relaxed" response during the first wave of the pandemic. However, increased rates of COVID-19 cases led to a new approach that involved many more mandatory restrictions, thus making Sweden's response similar to Denmark's in the second wave of the pandemic.

Aim

The aim was to investigate and compare the extent to which the populations in Denmark and Sweden considered the COVID-19 restrictions to be acceptable during the first two waves of the pandemic. The study also aimed to identify the characteristics of those who were least accepting of the restrictions in the two countries.

Materials and methods

Cross-sectional surveys were conducted in Denmark and Sweden in 2021. The study population was sampled from nationally representative web panels in the two countries, consisting of 2,619 individuals from Denmark and 2,633 from Sweden. The questionnaire captured key socio-demographic characteristics. Acceptability was operationalized based on a theoretical framework consisting of seven constructs and one overarching construct.

Results

The respondents' age and gender patterns were similar in the two countries. The proportion of respondents in Denmark who agreed with the statements ("agree" alternative) that captured various acceptability constructs was generally higher for the first wave than the second wave of the pandemic. The opposite pattern was seen for Sweden. In Denmark, 66% in the first wave and 50% in the second wave were accepting of the restrictions. The corresponding figures for Sweden was 42% (first wave) and 47% (second wave). Low acceptance of the restrictions, defined as the 25% with the lowest total score on the seven acceptability statements, was associated with younger age, male gender and lower education levels.

Conclusion

Respondents in Sweden were more accepting of the restrictions in the second wave, when the country used many mandatory restrictions. In contrast, respondents in Denmark were more accepting of the restrictions in the first wave than in the second wave, implying an increased weariness to comply with the restrictions over time. There were considerable socio-demographic differences between those who expressed low acceptance of the restrictions and the others in both countries, suggesting the importance of tailoring communication about the pandemic to different segments of the population.

Predicting COVID-19 exposure risk perception using machine learning

BACKGROUND

Self-perceived exposure risk determines the likelihood of COVID-19 preventive measure compliance to a large extent and is among the most important predictors of mental health problems. Therefore, there is a need to systematically identify important predictors of such risks. This study aims to provide insight into forecasting and understanding risk perceptions and help to adjust interventions that target various social groups in different pandemic phases.

METHODS

This study was based on survey data collected from 5001 Norwegians in 2020 and 2021. Interpretable machine learning algorithms were used to predict perceived exposure risks. To detect the most important predictors, the models with best performance were chosen based on predictive errors and explained variances. Shapley additive values were used to examine individual heterogeneities, interpret feature impact and check interactions between the key predictors.

RESULTS

Gradient boosting machine exhibited the best model performance in this study (2020: RMSE=.93, MAE=.74, RSQ=.22; 2021: RMSE=.99, MAE=.77, RSQ=.12). The most influential predictors of perceived exposure risk were compliance with interventions, work-life conflict, age and gender. In 2020, work and occupation played a dominant role in predicting perceived risks whereas, in 2021, living and behavioural factors were among the most important predictors. Findings show large individual heterogeneities in feature importance based on people's sociodemographic backgrounds, work and living situations.

CONCLUSION

The findings provide insight into forecasting risk groups and contribute to the early detection of vulnerable people during the pandemic. This is useful for policymakers and stakeholders in developing timely interventions targeting different social groups. Future policies and interventions should be adapted to the needs of people with various life situations.

Behind closed doors: Protective social behavior during the COVID-19 pandemic

The success of personal non-pharmaceutical interventions as a public health strategy requires a high level of compliance from individuals in private social settings. Strategies to increase compliance in these hard-to-reach settings depend upon a comprehensive understanding of the patterns and predictors of protective social behavior. Social cognitive models of protective behavior emphasize the contribution of individual-level factors while social-ecological models emphasize the contribution of environmental factors. This study draws on 28 waves of survey data from the Understanding Coronavirus in America survey to measure patterns of adherence to two protective social behaviors-private social-distancing behavior and private masking behavior-during the COVID-19 pandemic and to assess the role individual and environmental factors play in predicting adherence. Results show that patterns of adherence fall into three categories marked by high, moderate, and low levels of adherence, with just under half of respondents exhibiting a high level of adherence. Health beliefs emerge as the single strongest predictor of adherence. All other environmental and individual-level predictors have relatively poor predictive power or primarily indirect effects.

Socioeconomic and risk-related drivers of compliance with measures to prevent SARS-CoV-2 infection: evidence from the Munich-based KoCo19 study

OBJECTIVES

Although a growing share of the population in many countries has been vaccinated against the SARS-CoV-2 virus to different degrees, social distancing and hygienic non-pharmaceutical interventions still play a substantial role in containing the pandemic. The goal of this study was to investigate which factors are correlated with a higher compliance with these regulations in the context of a cohort study in the city of Munich, southern Germany, during the summer of 2020, i.e. after the first lockdown phase.

METHODS

Using self-reported compliance with six regulations and personal hygiene rules (washing hands, avoiding touching face, wearing a mask, keeping distance, avoiding social gatherings, avoiding public spaces) we extracted two compliance factor scores, namely compliance with personal hygiene measures and compliance with social distancing regulations. Using linear and logistic regressions, we estimated the correlation of several socio-demographic and risk perception variables with both compliance scores.

RESULTS

Risk aversion proved to be a consistent and significant driver of compliance across all compliance behaviors. Furthermore, being female, being retired and having a migration background were positively associated with compliance with personal hygiene regulations, whereas older age was related with a higher compliance with social distancing regulations. Generally, socioeconomic characteristics were not related with compliance, except for education, which was negatively related with compliance with personal hygiene measures.

CONCLUSIONS

Our results suggest that for a targeted approach to improve compliance with measures to prevent SARS-CoV-2 infection, special attention should be given to younger, male and risk-prone individuals.

When norms collide: The effect of religious holidays on compliance with COVID guidelines

Aim

This paper investigates the effect of a religious holiday (Eid-ul-Fitr in Pakistan) on compliance behaviour instituted during the COVID-19 pandemic. Longstanding religion-based norms of behaviour during the Eid holidays (traveling to meet family members, praying in large gatherings, hugging) may counteract newly established (and weaker) norms of health-preserving behaviours.

Method

We study the impact of Eid-ul-Fitr on compliance with COVID guidelines for a sample of university students. Our effects are identified by unprompted delays in fielding a survey measuring compliance with prescribed behaviours.

Results

We find that compliance with guidelines declines immediately after the religious holiday in our sample of students, with no observable decline in other well documented predictors of compliance behaviour (risk perceptions, trust in the authorities). We find that this decline in compliance is largely attributable to male participants, with one important exception. We further confirm our results by conducting robustness checks incorporating matching techniques and a smaller follow-up study where we randomize invitations to the survey.

Conclusion

We conclude that amid the pandemic, newly formed norms pertaining to healthcare guidelines (focusing on social-distancing) emerged, and were subsequently undercut by longstanding norms of behaviour following a religious celebration: Eid-ul-Fitr. This paper underscores the fragility of these newly emerged norms, especially when challenged by a more well-entrenched, traditional norm.

A machine learning approach to predict self-protecting behaviors during the early wave of the COVID-19 pandemic

Using a unique harmonized real-time data set from the COME-HERE longitudinal survey that covers five European countries (France, Germany, Italy, Spain, and Sweden) and applying a non-parametric machine learning model, this paper identifies the main individual and macro-level predictors of self-protecting behaviors against the coronavirus disease 2019 (COVID-19) during the first wave of the pandemic. Exploiting the interpretability of a Random Forest algorithm via Shapely values, we find that a higher regional incidence of COVID-19 triggers higher levels of self-protective behavior, as does a stricter government policy response. The level of individual knowledge about the pandemic, confidence in institutions, and population density also ranks high among the factors that predict self-protecting behaviors. We also identify a steep socioeconomic gradient with lower levels of self-protecting behaviors being associated with lower income and poor housing conditions. Among socio-demographic factors, gender, marital status, age, and region of residence are the main determinants of self-protective measures.

Effects of Cognitive Appraisals on Perceived Self-Efficacy and Distress during the COVID-19 Lockdown: An Empirical Analysis Based on Structural Equation Modeling

During the COVID-19 lockdown, individuals and households had to responsibly manage the difficulties and problems caused by the restrictions on their mobility, such as the interruptions to work schedules, insecure food supplies, and the procurement of services and health care. The perceptions of risk as well as the fear of disease were strongly linked to worry, defined as a sequence of thoughts that evoke negative emotions and elevated levels of anxiety and distress. This study evaluated how different cognitive appraisals of an individual's sources of worry could influence their perceived self-efficacy and directly or indirectly moderate their perceived general distress. A sample of 544 participants completed a survey that included questions based on the generalized self-efficacy scale, the sources of concern during the epidemic, the cognitive appraisal scale in emergency, and perceived discomfort. Subsequently, a structural-equation-modeling (SEM) analysis was performed to test the moderating role of cognitive appraisals and perceived self-efficacy on participants' overall distress during a lockdown. Overall, the model reported acceptable fit values and confirmed the hypotheses of the study. An individual's worries activated either a dysfunctional threat appraisal, which prompted a fear-and-closure response that then increased their overall state of distress; or two other functional appraisals (i.e., adaptive or supportive) that contributed to significantly improving the individual's self-efficacy. Higher self-efficacy was shown to be associated with lower levels of perceived distress. For the purposes of prevention and distress containment, it would be appropriate to promote psycho-educational interventions that promote the adoption of appraisal strategies that are functional and beneficial for perceived self-efficacy.

Factors associated with non-pharmaceutical interventions compliance during COVID-19 pandemic: a Portuguese cross-sectional survey

BACKGROUND

The use of non-pharmaceutical interventions (NPI) is one of the main tools used in the coronavirus disease 2019 (COVID-19) pandemic response, including physical distancing, frequent hand washing, face mask use, respiratory hygiene and use of contact tracing apps. Literature on compliance with NPI during the COVID-19 pandemic is limited.

METHODS

We studied this compliance and associated factors in Portugal, between 28th October 2020 and 11th January 2021 (Portuguese second and third waves of the pandemic), using logistic regressions. Data were collected through a web-based survey and included questions regarding NPI compliance, COVID-19-related concerns, perception of institutions' performance, agreement with the measures implemented and socio-demographic characteristics.

RESULTS

From the 1263 eligible responses, we found high levels of compliance among all COVID-19 related NPI, except for the contact tracing app. Females and older participants showed the highest compliance levels, whereas the opposite was observed for previously infected participants. There was heterogeneity of COVID-19 NPI compliance across Portuguese regions and a clear gradient between concern, government performance's perception or agreement and compliance.

CONCLUSIONS

Results suggested areas for further study with important implications for pandemic management and communication, for future preparedness, highlighting other factors to be accounted for when recommending policy measures during public health threats.

Fear of COVID-19 is associated with trust, subjective numeracy, and differentially with loneliness in older versus younger adults

Introduction

The emotional impacts of the COVID-19 pandemic and resulting public health emergency are only beginning to be understood.

Methods

We assessed the contributions of emotional and cognitive factors and age-related comorbidities to greater COVID-19 fear in a community dwelling sample of 142 younger (M_age = 19.63, SD_age = 2.59) and 157 older (M_age = 72.01, SD_age = 7.06) adults, between July 2020 and July 2021. We hypothesized that individuals with increased loneliness, depression, and/or decreased subjective numeracy (SN) and interpersonal trust would experience more COVID-19 fear. We also predicted that females and older adults would experience more COVID-19 fear given that age-related comorbidities are associated with increased illness severity.

Results

Results showed that the extent of loneliness in older adults was more strongly related to fear of COVID-19 than it was in younger adults (β = 0.197, p = 0.016), and poorer SN was associated with increased COVID-19 fear in both age groups (β = -0.138, p = 0.016). Further, higher interpersonal mistrust was associated with increased COVID-19 fear (β = 0.136, p = 0.039), as was identifying as female (β = 0.137, p = 0.013).

Discussion

Given that self-described poor numeracy was a marker for greater COVID-19 fear, investigators and policy makers might consider mitigation opportunities addressing data literacy requirements imposed by the media. Further, outreach to mitigate loneliness, particularly of the elderly, might effectively lessen the negative psychological impact of this ongoing public health crisis.

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.

Deontologists are not always trusted over utilitarians: revisiting inferences of trustworthiness from moral judgments

Recent research has looked at how people infer the moral character of others based on how they resolve sacrificial moral dilemmas. Previous studies provide consistent evidence for the prediction that those who endorse outcome-maximizing, utilitarian judgments are disfavored in social dilemmas and are seen as less trustworthy in comparison to those who support harm-rejecting deontological judgments. However, research investigating this topic has studied a limited set of sacrificial dilemmas and did not test to what extent these effects might be moderated by specific features of the situation described in the sacrificial dilemma (for instance, whether the dilemma involves mortal or non-mortal harm). In the current manuscript, we assessed the robustness of previous findings by exploring how trust inference of utilitarian and deontological decision makers is moderated by five different contextual factors (such as whether the sacrificial harm is accomplished by an action or inaction), as well as by participants' own moral preferences. While we find some evidence that trust perceptions of others are moderated by dilemma features, we find a much stronger effect of participants' own moral preference: deontologists favored other deontologists and utilitarians favored utilitarians. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on 21 September 2022. The protocol, as accepted by the journal, can be found at: https://doi.org/10.6084/m9.figshare.21325953 .

Health persuasion through emoji: How emoji interacted with information source to predict health behaviors in COVID-19 situation

By providing health information through visual communication, public health organizations can effectively guide and persuade people to adopt healthy behaviors, which is critical in the context of public health crises. In this study, drawing upon congruity theory and the premise of visual communication, we examined how information source and emoji may shape people's preventive and self-protective behaviors through perceived fear (PF) and perceived controllability (PC). Using a convenience sample of 210 participants, we conducted a 2 (emoji: with versus without) × 2 (information source: official versus unofficial) between-subject experiment. The results indicated that, compared with nonuse, the use of emoji in information resulted in higher PF, stronger preventive behavioral intention (PBI), and lower PC. In addition, a strong interaction effect was observed between emoji and the source of information on PBI. When emoji were added to health information released by an unofficial organization, the text outperformed that from an official agency in persuading people to adopt preventive behaviors. Furthermore, we determined that PF mediated the effect of emoji on PBI, but only for unofficial information sources. These results provide a reference for enhancing the effectiveness of health information including visual cues, such as emoji.

Seroprevalence of SARS-CoV-2 Antibodies in Denmark: Results of Two Nationwide Population-Based Surveys, February and May 2021

Background

Seroprevalence studies can be used to measure the progression of national COVID-19 epidemics. The Danish National Seroprevalence Survey of SARS-CoV-2 infections (DSS) was conducted as five separate surveys between May 2020 and May 2021. Here, we present results from the two last surveys conducted in February and May 2021.

Methods

Persons aged 12 or older were randomly selected from the Danish Population Register and those having received COVID-19 vaccination subsequently excluded. Invitations to have blood drawn in local test centers were sent by mail. Samples were analyzed for whole Immunoglobulin by ELISA. Seroprevalence was estimated by sex, age and geography. Comparisons to vaccination uptake and RT-PCR test results were made.

Results

In February 2021, we found detectable antibodies in 7.2% (95% CI: 6.3-7.9%) of the invited participants (participation rate 25%) and in May 2021 in 8.6% (95% CI: 7.6-9.5%) of the invited (participation rate: 14%). Seroprevalence did not differ by sex, but by age group, generally being higher among the <50 than 50+ year-olds. In May 2021, levels of seroprevalence varied from an estimated 13% (95% CI: 12-15%) in the capital to 5.2% (95% CI: 3.4-7.4%) in rural areas. Combining seroprevalence results with vaccine coverage, estimates of protection against infection in May 2021 varied from 95% among 65+ year-olds down to 10-20% among 12-40 year-olds. In March-May 2021, an estimated 80% of all community SARS-CoV-2 infections were diagnosed by RT-PCR and captured by surveillance.

Conclusion

Seroprevalence estimates doubled during the 2020-21 winter wave of SARS-CoV-2 infections and then stabilized as vaccinations were rolled out. The epidemic affected large cities and younger people the most. Denmark saw comparatively low infections rates, but high test coverage; an estimated four out of five infections were detected by RT-PCR in March-May 2021.

Satisfaction With Governmental Risk Communication Both Increases and Decreases COVID-19 Mitigation Behaviours

Objectives: Over 3 years of the COVID-19 pandemic, and intense societal and governmental response, a wealth of research has examined risk perceptions and public risk mitigation behaviours. The vast majority of this inquiry has focused on health risks. Nevertheless, as a "total social fact" influencing nearly every aspect of quotidian life, the pandemic engenders a wide range of risk perceptions. Methods: Via a survey (N = 4,206) of representative samples of the general public in five European countries (Germany, Norway, Sweden, Switzerland, United Kingdom), we explore perceptions of a range of personal/public health, economic, and societal risks. We also investigate the effects of perceptions of official governmental risk communication in one's country on risk perceptions and risk mitigation behaviours. Results: Structural equation modelling reveals that whilst perceptions of effective risk communication directly increase behaviours that mitigate COVID-19 health risks, these same perceptions indirectly decrease behaviour frequency via a mediated relationship with societal risk perceptions. Conclusion: The findings highlight the import of governmental authorities analysing and communicating about the range of risk perceptions citizens might have about a "total social fact" such as COVID-19.

From delta to omicron: The role of individual factors and social context in self-reported compliance with pandemic regulations and recommendations

As SARS-CoV-2 spreads especially when larger groups gather (e.g., at the workplace), it is crucial to understand compliance with regulations and recommendations in such settings. Using data from adults in Germany (N = 29,355) assessed between October 2021 and February 2022, we investigated factors associated with self-reported compliance in both private and working life and how these relate to each other. The results indicate that private compliance was stronger among older individuals and females; among those who worried more about the pandemic situation and assumed that infection was more severe; among those who trusted the government more; and among those who did not perceive public health measures as exaggerated. Private compliance was also associated with personality traits; in particular, individuals who followed regulations and recommendations were likely to be more introverted, conscientious, open, and agreeable. Compliance at work related to both private compliance and colleagues' behaviors. Individuals whose private compliance was high also complied at work. However, when private compliance was low, compliance at work aligned with colleagues' behaviors; that is, compliance at work was high when colleagues complied and low when they did not. The observed effects were stable over time. In summary, they suggest that compliance with regulations and recommendations depends on individual risk perception, trust in government, perception of required or recommended measures, and social norms. To promote protective behaviors in contexts where larger groups gather (including workplaces), making positive social norms more salient (e.g., by supporting role models) may prove especially useful.

Cognitive and Emotional Motivation to Explain Infection-Prevention Behaviors with Social Support as a Mediator During the COVID-19 Pandemic: A Nationwide Cross-Sectional Study in Korea

Purpose

To predict the performance of infection-prevention behaviors among adults in Korea based on the health belief model, using social support as a mediator.

Patients and Methods

A nationwide cross-sectional survey of 700 participants from the local community was conducted using both online and offline methods from 8 metropolitan cities and 9 provinces in Korea from November 2021 to March 2022. The questionnaire was composed of 4 sections: demographic information, motivational factors for behavior change, social support, and infection-prevention behaviors. Data were analyzed using structural equation modeling with the AMOS program. The general least-squares method was applied to assess the fit of the model and the bootstrapping method was tested for indirect effect and the total effect.

Results

Motivation factors that directly affected infection-prevention behaviors were self-efficacy (γ=0.58, p<0.001), perceived barriers (γ=-.08, p=0.004), perceived benefits (γ=0.10, p=0.002), perceived threats (γ=0.08, p=0.009), and social support (γ=0.13, p<0.001), after controlling for related demographic variables. Cognitive and emotional motivation factors together explained 59% of the variance in infection-prevention behaviors. Social support exerted significant mediating effects between each cognitive and emotional motivation variable and infection-prevention behaviors, along with a significant direct effect on infection-prevention behaviors (γ=0.12, p<0.001).

Conclusion

The engagement of prevention behaviors among community-dwelling adults was influenced by their self-efficacy, perceived barriers, perceived benefits, and perceived threats with social support as a mediator. Prevention policy approaches could include providing specific information to improve self-efficacy and build awareness of the severity of the disease while establishing a supportive social environment for promoting health behaviors during the COVID-19 pandemic.

Satisfaction with pandemic management and compliance with public health measures: Evidence from a German household survey on the COVID-19 crisis

We study how satisfaction with government efforts to respond to the COVID-19 crisis affects compliance with pandemic mitigation measures. Using a novel longitudinal household survey for Germany, we overcome the identification and endogeneity challenges involved in estimating individual compliance by using an instrumental variable approach that exploits exogenous variation in two indicators measured before the crisis: political party preferences and the mode of information measured by the frequency of using social media and reading newspapers. We find that a one unit increase in subjective satisfaction (on the 0-10 scale) improves protective behavior by 2-4 percentage points. Satisfaction with the government's COVID-19 management is lower among individuals with right-wing partisan preferences and among individuals who use only social media as an information source. Overall, our results indicate that the effectiveness of uniform policy measures in various domains, such as the health system, social security or taxation, especially during pandemic crises, cannot be fully evaluated without taking individual preferences for collective action into account.

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.

Potential Factors Conditioning the Compliance to Mandatory Face Covering in the Public Space Due to SARS-CoV-2 Pandemic

BACKGROUND

During the SARS-CoV-2 pandemic, we could observe different attitudes towards restrictive bans and orders.

AIM

The research aimed to examine the potential psychological factors, such as generalized anxiety, fear of COVID-19 or social approval, related to the approach to mandatory face covering in public spaces.

METHODS

The web-assisted interviews survey was used among 202 participants, which included socio-demographical data, approach to face covering, the Generalized Anxiety Disorder Scale, the COVID-19 Anxiety Scale, and The Questionnaire of Social Approval.

RESULT

The data showed a statistically significant correlation between compliance to the rule of face and nose covering vs. anxiety and compliance to the rule of face and nose covering vs. generalized anxiety. The results indicate differences between vaccinated and non-vaccinated people in the anxiety of COVID-19, generalized anxiety, and compliance with the rule of face and nose covering.

CONCLUSIONS

People vaccinated has a higher level of anxiety and more often compliance with the rule of face covering. It is worth noting that an overly pronounced fear of COVID-19 could be a risk factor for mental health. More research about coping with anxiety in the group of vaccinated people is recommended.

Descriptive, injunctive, or the synergy of both? Experimenting normative information on behavioral changes under the COVID-19 pandemic

Backgrounds

The effectiveness of citizens' behavioral changes to prevent the spread of SARS-CoV-2, such as avoiding large social events, relies on science communication from policymakers and collective action among peer citizens. Extant studies recognize the potential effects of information stimuli on citizens' behavioral changes, including what epidemiological experts request (injunctive information) and what surrounding people behave (descriptive information). Yet, they have insufficiently assessed the co-occurrence and possible interaction of multiple information stimuli.

Methods

1,819 Japanese citizens aged 18 or over were recruited for an experimental survey during March 1-3, 2021 and asked their views on a hypothetical wedding attendance in Japan while being exposed to randomly assigned normative information stimuli. Their willingness to attend a wedding asked before and after the intervention was measured. Infection risk perception was also asked as a mediating variable.

Results

Findings suggest the constant supremacy of descriptive information and no synergistic effects in the interaction of multiple information stimuli. We also report that the effects of injunctive and descriptive information vary according to participants' risk perception, age, and trust in experts.

Conclusion

Our experimental test enables a systematic assessment of multiple normative information and confirms the primacy of descriptive information as the main driver of behavioral change. Communication by medical experts has limitations but is still effective in specific categories of the population.

Perceived threat of COVID-19, attitudes towards vaccination, and vaccine hesitancy: A prospective longitudinal study in the UK

OBJECTIVES

Using the Health Belief Model as a conceptual framework, we investigated the association between attitudes towards COVID-19, COVID-19 vaccinations, and vaccine hesitancy and change in these variables over a 9-month period in a UK cohort.

METHODS

The COPE study cohort (n = 11,113) was recruited via an online survey at enrolment in March/April 2020. The study was advertised via the HealthWise Wales research registry and social media. Follow-up data were available for 6942 people at 3 months (June/July 2020) and 5037 at 12 months (March/April 2021) post-enrolment. Measures included demographics, perceived threat of COVID-19, perceived control, intention to accept or decline a COVID-19 vaccination, and attitudes towards vaccination. Logistic regression models were fitted cross-sectionally at 3 and 12 months to assess the association between motivational factors and vaccine hesitancy. Longitudinal changes in motivational variables for vaccine-hesitant and non-hesitant groups were examined using mixed-effect analysis of variance models.

RESULTS

Fear of COVID-19, perceived susceptibility to COVID-19, and perceived personal control over COVID-19 infection transmission decreased between the 3- and 12-month surveys. Vaccine hesitancy at 12 months was independently associated with low fear of the disease and more negative attitudes towards COVID-19 vaccination. Specific barriers to COVID-19 vaccine uptake included concerns about safety and efficacy in light of its rapid development, mistrust of government and pharmaceutical companies, dislike of coercive policies, and perceived lack of relaxation in COVID-19-related restrictions as the vaccination programme progressed.

CONCLUSIONS

Decreasing fear of COVID-19, perceived susceptibility to the disease, and perceptions of personal control over reducing infection-transmission may impact future COVID-19 vaccination uptake.

To Vaccinate or Not to Vaccinate-Reasons of Willingness and Reluctance of Students against SARS-CoV-2 Vaccination-An International Experience

Despite the vaccine against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) being reported to be safe and effective, the unwillingness to vaccinate and doubts are still common. The aim of this international study was to assess the major reasons for the unwillingness to vaccinate in a group of students from Poland (n = 1202), Bangladesh (n = 1586), India (n = 484), Mexico (n = 234), Egypt (n = 566), Philippines (n = 2076), Pakistan (n = 506), Vietnam (n = 98) and China (n = 503). We conducted an online cross-sectional study that aimed to assess (1) the percentage of vaccinated and unvaccinated students and (2) the reasons associated with willingness/unwillingness to the vaccine. The study included 7255 respondents from 9 countries with a mean age of 21.85 ± 3.66 years. Only 22.11% (n = 1604) of students were vaccinated. However, the majority (69.25%, n = 5025) expressed a willingness to be vaccinated. More willing to vaccinate were students in informal relationships who worked mentally, used psychological/psychiatric services before the pandemic, and studied medicine. There are cultural differences regarding the reasons associated with the unwillingness to vaccinate, but some 'universal' might be distinguished that apply to the whole group.

Comparing coronavirus (COVID-19) and climate change perceptions: Implications for support for individual and collective-level policies

COVID-19 (coronavirus) and climate change are both global issues that have wide-reaching and serious consequences for human health, the economy, and social outcomes for populations around the world, and both require a combination of systemic governmental policies and community support for action. This paper compares people's responses to the coronavirus pandemic and climate change in the United Kingdom (UK). A representative survey of the UK population (n = 1,518) conducted in November and December 2020 explored public perceptions of (a) personal and government responsibility, (b) efficacy and trust, and (c) support for policies to address the two issues. The results show that, while there are a number of similarities between coronavirus and climate change, major differences exist regarding individual action. In comparison to the coronavirus pandemic, people feel less personal responsibility, think that their own personal actions are less efficacious, and express lower levels of support for (in particular individual-level) policies to address climate change. These findings suggest that experiences from the coronavirus pandemic cannot directly be translated to climate change, and thus that climate change is likely to require different policy responses and framing.

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

BACKGROUND

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

PURPOSE

To explore trajectories of compliance with COVID-19 guidelines.

METHODS

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

RESULTS

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

CONCLUSIONS

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