Health knowledge and self-efficacy to make health behaviour changes: a survey of older adults living in Ontario social housing

Effects of the Community Paramedicine at Clinic (CP@clinic) program on the health behaviours of older adults residing in social housing: secondary outcomes of a cluster-randomized trial

BACKGROUND

Community-dwelling, low-income older adults who reside in social housing are a vulnerable population with high rates of poor health behaviours that contribute to chronic health conditions and adverse health outcomes. This study investigates the impact of the Community Paramedicine at Clinic (CP@clinic), a chronic disease prevention, management, and health promotion program, on the health behaviours of this population.

METHODS

An open-label, pragmatic cluster-randomized controlled trial with parallel intervention and control groups was conducted for one-year within 30 social housing buildings in Ontario, Canada. Eligible buildings were required to have a postal code not shared with other addresses, a majority of tenants aged 55 years or older, at least 50 units, and a similar building available for matching. Buildings were paired and randomized to either intervention (CP@clinic program) or control (usual care) groups. The CP@clinic program was conducted in the common spaces of the intervention buildings and consisted of weekly drop-in sessions facilitated by trained community paramedics. Older adults met one-on-one with community paramedics who conducted evidence-based risk assessments, made referrals to community and healthcare resources, provided health education, and reported health assessment results back to family physicians. Pre- and post-intervention surveys were conducted. Descriptive statistics were used to describe demographic characteristics and health behaviours. Mann-Whitney U tests were conducted to compare individual-level change in health behaviours between intervention and control groups.

RESULTS

From the 15 intervention and 15 control buildings, 656 participants completed either the pre- and/or post-intervention survey; the mean age was 72.1 (SD 8.7) years, 75.6% were female, 91.6% were not married, 89% were white, 68.4% obtained a high school education or less, and 90% lived alone. After the intervention, the individual-level consumption of weekly fruit and vegetables and time spent watching TV improved significantly (p < 0.05) for the intervention group compared to the control group (z-scores = -2.467 and -2.194, respectively). The change in consumption of carbohydrate/grains increased significantly for the intervention group compared to the control group (z-score -2.023, p < 0.05).

CONCLUSION

The CP@clinic program is an innovative wellness program that had a significant impact in changing health behaviours, especially in weekly fruit and vegetable consumption, among a vulnerable older adult population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02152891, registered June 6, 2014.

Hypertension self-management trajectory patterns and associated factors among Chinese patients with aortic dissection after surgical repair: a longitudinal study

AIMS

In patients with aortic dissection (AD) after surgical repair, especially those with hypertension, better management of blood pressure is associated with better health outcomes. The aim of this study is to identify hypertension self-management trajectory patterns and associated factors among Chinese aortic dissection patients after surgical repair to assist in developing tailored behavioural interventions for this population.

METHODS AND RESULTS

178 patients with aortic dissection who underwent surgical repair were followed for 3 months. Data on hypertension self-management, hypertension knowledge, self-efficacy, and social support were collected before discharge and at 1 and 3 months after discharge. Sociodemographic and clinical data were also collected. A latent class growth model and generalized estimating equations were used to explore hypertension self-management trajectory patterns and factors associated with each pattern. The participants' average age was 57.95 (± 11.27) years. Two hypertension self-management trajectory patterns were identified: 'rapid ascent then suppressed growth' (93.4%) and 'continuously slow ascent' (6.6%). For the 'rapid ascent then suppressed growth' pattern, age, educational background, type of health insurance, family monthly income, self-efficacy, and social support were associated with this pattern (P < 0.05).

CONCLUSION

Healthcare providers may prioritize hypertension self-management for patients who are younger, have lower educational levels, have resident or employee medical insurance and have a family monthly income between 5001 and 10 000 yuan. Self-efficacy and social support might serve as targets for future intervention to improve hypertension self-management.

REGISTRATION

ChiCTR2100050542.

Tailoring implementation strategies for the healthy actions and lifestyles to Avoid Dementia or Hispanos y el ALTo a la Demencia Program: Lessons learned from a survey study

BACKGROUND

Healthy Actions and Lifestyles to Avoid Dementia Program (HALT-AD) or Hispanos y el ALTo a la Demencia is a recently-developed online educational platform to help individuals identify and modify their own dementia modifiable risk factors (MRF). In light of known challenges in recruiting and retaining diverse participants in research studies, there is a need to identify data-informed strategies that will contribute to effective outreach and tailored implementation of HALT-AD among its intended users of Hispanic and non-Hispanic midlife and older adults in the US.

OBJECTIVES

To identify factors (i.e, demographic, medical, psychosocial and environmental) that may facilitate or impede effective program enrollment and participation.

DESIGN

Cross-sectional study SETTING: Data from an online and self-administered survey conducted between January and April 2023 PARTICIPANTS: Residents of California, predominately San Diego, who were 50 to 85 years old, with no dementia or Alzheimer's disease, proficient in English or Spanish and with enough technical ability to complete the survey electronically (n=157; 43% Hispanic). INTERVENTION (IF ANY): none MEASUREMENTS: RedCap was used to capture answers to closed and open-ended survey questions. Mixed-methods analysis was used: For quantitative data, descriptive statistics, comparisons by group (Hispanic/non-Hispanic), and exploratory factor analysis were conducted in SPSS. Thematic analysis with open coding in Excel was used for qualitative responses.

RESULTS

Independent of ethnicity, participants' most preferred method of reach for recruitment was through a conversation with their doctor or with a family member or friend. Their least preferred method was receiving a Facebook advertisement especially among non-Hispanics. Interest in program participation did not differ by sociodemographic characteristics or self-rated satisfaction with individualized MRFs. Instead, having higher confidence in one's ability to commit to behavior change was significantly associated with higher interest in program participation. While a common theme to motivate both groups to participate was the potential to decrease dementia risk, non-Hispanics were motivated by the premise of supporting research and having a positive user experience. For program implementation, Hispanics were more likely to be interested in participating if live sessions, either online or in-person, were provided to offer support with making lifestyle changes as adjunct to completing online courses independently. In both groups, participation may be further facilitated by offering wearable devices which provide participants with feedback on lifestyle change progress.

CONCLUSIONS

A "one-size-fits-all" approach to recruitment and implementation of HALT-AD may not be effective in enrolling and retaining participants in future studies or for clinical use. Instead, a tailored approach that accounts for personal and ethnically-dependent preferences may be more beneficial.

Association between dental floss use and atherosclerotic cardiovascular disease in American adults

BACKGROUND

Atherosclerotic cardiovascular disease (ASCVD) remains a major cause of global morbidity and mortality. Emerging research suggests that oral hygiene practices, particularly dental floss use, may reduce the risk of ASCVD.

OBJECTIVES

The purpose of this study was to examine the association between dental floss use and ASCVD prevalence.

METHODS

Data from NHANES participants who completed home interviews and dental evaluations were analyzed. ASCVD was defined as angina, stroke, myocardial infarction, or coronary artery disease. Dental floss use was self-reported over the past seven days. Covariates included demographic, socioeconomic, lifestyle, and clinical factors. Weighted logistic regression was used to assess the relationship between dental floss use and ASCVD prevalence.

RESULTS

This study included a total sample of 7253 participants with a mean age of 53.8±14.6 years. The sample consisted of 47.6 % male participants. The ethnic composition included 64.3 % Non-Hispanic White. Regular dental floss use was correlated with a lower likelihood of developing ASCVD and Stringent Criteria (infarction or stroke), with ORs of 0.76 (95 % CI: 0.60, 0.97) p=0.028 and 0.68 (95 % CI: 0.49, 0.94) p=0.022, respectively. Flossing 3-4 days/week was associated with reduced ASCVD risk, OR = 0.57 (95 % CI: 0.38, 0.84) p=0.006. Similar reductions were seen for stringent criteria: flossing 3-4 days/week: OR = 0.57 (95 % CI: 0.32, 0.99) p=0.047, flossing ≥5 days/week: OR = 0.69 (95 % CI: 0.47, 1.00) p=0.049.

CONCLUSIONS

Regular dental floss use may reduce the risk of ASCVD. These results support the inclusion of oral hygiene practices in cardiovascular disease prevention strategies.

Diabetes knowledge and behaviour: a cross-sectional study of Jordanian adults

AIMS/HYPOTHESIS

Diabetes mellitus is a significant global health concern that is projected to affect 7.7% of the global population by 2030. Understanding factors that influence diabetes knowledge and management adherence is crucial for effective diabetes mellitus management and prevention. This study investigates the relationships between demographic and clinical factors and their impact on diabetes knowledge and behaviour, as well as the potential influence of diabetes knowledge on management behaviours.

METHODS

The study comprised a cross-sectional survey of 1050 adults, collecting data on age, sex, marital status, education, employment, hypertension, dyslipidaemia (any lipid imbalance, such as high cholesterol, high LDL-cholesterol or low HDL-cholesterol), smoking and diabetes status. Two multiple linear regression models were used to identify factors associated with diabetes knowledge and behaviour, and a simple linear regression model was used to assess the relationship between knowledge and behaviour.

RESULTS

Significant associations were found between diabetes knowledge and the following factors: age (44.32 ± 9.53 for ≥50 years vs 39.73 ± 9.95 for 18 to <25 years; p<0.0001), sex (49.00 ± 12.35 for women vs 45.09 ± 13.27 for men; p<0.0001), marital status (50.92 ± 11.69 for married vs 45.39 ± 13.10 for single; p<0.0001), smoking status (45.78 ± 13.22 for smokers vs 48.22 ± 12.15 for non-smokers; p=0.003), hypertension (46.46 ± 13.11 for present vs 47.31 ± 12.87 for absent; p=0.007) and diabetes status (69.49 ± 17.35 for present vs 62.76 ± 16.88 for absent; p<0.001). Behaviour scores correlated similarly with these factors except for diabetes and smoking status. The adjusted simple linear regression model revealed that diabetes knowledge was significantly associated with better management behaviours (coefficient=0.0794, p<0.001) after adjusting for demographic and clinical factors.

CONCLUSIONS/INTERPRETATION

This study highlights the importance of demographic and clinical factors in the context of diabetes knowledge and behaviours, underscoring the need for targeted educational and preventive programmes to improve diabetes management, especially in vulnerable populations. Additionally, the strong association between diabetes knowledge and management behaviours supports a knowledge-attitude-behaviour (KAB) model of diabetes management.

The influence of family health on self-efficacy in patients with chronic diseases: the mediating role of perceived social support and the moderating role of health literacy

BACKGROUND

Chronic diseases are a global health challenge, and therefore, more attention should be paid to improving self-efficacy in people with chronic diseases. This study examined the relationship between family health and self-efficacy, and explored the mediating role of perceived social support and the moderating role of health literacy. The aim is to enhance the self-efficacy of chronic patients by improving family health, social support, and health literacy, thereby improving their physical and mental state.

METHODS

A cross-sectional study based on psychological and behavioural factors was conducted, namely, the 2022 China Residents Survey, which included 5150 Chinese patients with chronic diseases. The General Self-Efficacy Scale-Short Form was used to assess self-efficacy, the Health Literacy Questionnaire-short form was used to assess health literacy, the Perceived Social Support Scale-Short Form was used to evaluate perceived social support, and the Chinese version of the Family Health Scale-Short Form was used to assess family health status.

RESULTS

Family health of patients with chronic diseases had a significant positive effect on self-efficacy. Perceived social support was identified as a partial mediator between family health and self-efficacy, accounting for 59.39% of the total effect. Health literacy moderated the impact of family health on perceived social support and self-efficacy.

CONCLUSIONS

Chronic diseases have become a global health challenge, and more attention should be paid to improving the self-efficacy of the chronically ill population. Our results not only facilitate the understanding of the relationship mechanisms between family health and self-efficacy in chronic patients but can also serve as a guide for healthcare workers and policymakers who wish to provide better care for patients.

SARS-CoV-2 testing, test positivity and vaccination in social housing residents compared with the general population: a retrospective population-based cohort study

BACKGROUND

The consideration of unique social housing needs has largely been absent from the COVID-19 response, particularly in tailoring strategies to improve access to testing and vaccine uptake among vulnerable and high-risk populations in Ontario. Given the growing population of social housing residents, this study aimed to compare SARS-CoV-2 testing, positivity, and vaccination rates in a social housing population with those in a general population cohort in Ontario, Canada.

METHODS

This population-based cohort study used administrative health data from Ontario to examine SARS-CoV-2 testing, positivity and vaccination rates in social housing residents compared with the general population from 1 January 2020 to 31 December 2021. All comparisons were unadjusted, stratified by sex and age and evaluated using standardised differences.

RESULTS

The rates of SARS-CoV-2 PCR testing were lower among younger age groups and higher among older adults within the social housing cohort, compared with the general population cohort. SARS-CoV-2 test positivity was higher in social housing than in the general population among individuals aged 60-79 years (7.9% vs 5.3%, respectively) and 80 years and older (12.0% vs 7.9%, respectively). Overall, 34.3% of social housing residents were fully vaccinated, compared with 29.6% of the general population cohort. However, a smaller proportion of social housing residents had received a booster vaccine (36.7%) compared with the general population (52.4%).

CONCLUSION

Improved and targeted outreach strategies are needed to increase the uptake of COVID-19 booster vaccines among social housing residents.

Gratitude and Subjective Well-Being in Older Chinese Adults in Nursing Homes: The Mediating Roles of Self-Efficacy and Social Support

AIM

With an aging global population, there has been a growing interest in the subjective well-being (SWB) of older people. As a positive emotion, gratitude has been found to be significantly and positively associated with SWB. However, the mechanisms underlying the relationship between gratitude and SWB remain poorly understood. This study aimed to examine the mediating effects of social support and self-efficacy in the relationship between gratitude and SWB among older Chinese adults in nursing homes.

DESIGN

A cross-sectional study.

METHODS

A sample of 354 older adults in nursing homes aged 60 years and above was recruited across three nursing homes in Guangzhou, China. Participants completed the Gratitude Questionnaire-Six-Item Form, the World Health Organization's well-being index, the General Self-efficacy questionnaire and the Multidimensional Scale of Perceived Social Support. Structural equation modelling was used to evaluate the relationships between gratitude, self-efficacy, social support and SWB. A bootstrap test was performed to test mediating roles of self-efficacy and social support.

RESULTS

Gratitude was found to be significantly and positively associated with SWB (β = 0.294, p < 0.001). Self-efficacy and social support independently mediated the relationship between gratitude and SWB (indirect effect of self-efficacy: Standardised β = 0.105, 95% CI [0.061, 0.157]; indirect effect of social support: Standardised β = 0.116, 95% CI [0.444, 0.191], all p < 0.001). Additionally, the results indicated that the mediating effect of self-efficacy was not significantly different from that of social support in the link between gratitude with SWB.

CONCLUSION

These findings presented strong evidence that self-efficacy and social support provided the underlying mechanisms through which gratitude was associated with SWB in Chinese nursing home residents. This highlighted the need to develop interventions aiming at increasing gratitude, self-efficacy and social support to promote SWB among elderly people.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Online patient-provider communication and healthy ageing: the roles of health literacy and health self-efficacy

eHealth involves using digital technologies, like electronic health records and telemedicine, to enhance healthcare delivery and outcomes. For older adults, eHealth helps manage chronic conditions, access services remotely, and engage in preventive health, improving physical and psychological well-being. This study investigates the association between online patient-provider communication (OPPC) and older adults' quality of life (QoL, i.e. sleep quality, exercise and psychological health). The study also explores how health literacy and health self-efficacy mediate the relationship between OPPC and QoL. This study utilized data from the National Cancer Institute's Health Information National Trends Survey, collected in 2019 (HINTS 5 Cycle 3), specifically targeting individuals aged ≥ 60 (N = 2587). The associations among variables were analysed using structural equation modelling. OPPC was positively and significantly associated with health literacy (β = 0.53, p < 0.001). Health literacy was positively and significantly related to health self-efficacy (β = 0.02, p < 0.001). Health self-efficacy was significantly related to five dimensions of QoL: sleep quality (β = 0.20, p < 0.001), fruit and vegetable consumption (β = 0.13, p < 0.010), exercise (β = 0.59, p < 0.001), sedentariness (β = -0.58, p < 0.001) and psychological health (β = 0.24, p < 0.001). Besides, health literacy and health self-efficacy also mediated the influence of OPPC on QoL sequentially, being identificators as two serial mediators between OPPC and older adults' QoL. This study suggests that OPPC plays an important role in older adults' QoL.

Exploring the determinants of oral health care uptake among women with gestational diabetes mellitus: A qualitative study to develop a logic model and framework for an oral health intervention

INTRODUCTION

Gestational diabetes mellitus (GDM) is a condition of glucose intolerance in pregnancy. Oral health has been shown to mediate blood glucose management and pregnancy outcomes. There is also a greater prevalence of poor oral health in GDM pregnancies when compared to normoglycemic pregnancies. While current guidelines recommend an oral health review as part of diabetes and pregnancy management, it is under-considered in GDM care. Hence, it is important to understand how to improve oral health care in this context.

AIM

To explore the determinants of oral health care uptake among women with GDM to develop a logic model for an intervention to improve awareness and activation of oral health behaviours in this population.

METHODS

Semi-structured interviews were used to collect the data and the Theoretical Domains Framework inspired the interview guide. The study population consisted of UK-based women with GDM over 18 years of age. The data were analysed with Framework Analysis and the COM-B Model was used to orientate the data.

RESULTS

Seventeen women participated in the study. Five themes including knowledge about oral health; the health of the baby; the impact of the GDM diagnosis; social support and barriers and facilitators were found to influence the uptake of oral health care.

CONCLUSIONS

This study developed an evidence-based logic model of the determinants of oral health care uptake among women with GDM. This will serve as a framework for developing an oral health intervention. This study may be the starting point for initiating conversations about implementing oral health care in GDM management.

Role perceptions and experiences of adult children in remote glucose management for older parents with type 2 diabetes mellitus: a qualitative study

BACKGROUND

With the advent of the smart phone era, managing blood glucose at home through apps will become more common for older individuals with diabetes. Adult children play important roles in glucose management of older parents. Few studies have explored how adult children really feel about engaging in the glucose management of their older parents with type 2 diabetes mellitus (T2DM) through mobile apps. This study provides insights into the role perceptions and experiences of adult children of older parents with T2DM participating in glucose management through mobile apps.

METHODS

In this qualitative study, 16 adult children of older parents with T2DM, who had used mobile apps to manage blood glucose for 6 months, were recruited through purposive sampling. Semi-structured, in-depth, face-to-face interviews to explore their role perceptions and experiences in remotely managing their older parents' blood glucose were conducted. The Consolidated Criteria for Reporting Qualitative Research (COREQ) were followed to ensure rigor in the study. The data collected were analyzed by applying Colaizzi's seven-step qualitative analysis method.

RESULTS

Six themes and eight sub-themes were identified in this study. Adult children's perceived roles in glucose management of older parents with T2DM through mobile apps could be categorized into four themes: health decision-maker, remote supervisor, health educator and emotional supporter. The experiences of participation could be categorized into two themes: facilitators to participation and barriers to participation.

CONCLUSION

Some barriers existed for adult children of older parents with T2DM participating in glucose management through mobile apps; however, the findings of this study were generally positive. It was beneficial and feasible for adult children to co-manage the blood glucose of older parents. Co-managing blood glucose levels in older parents with T2DM can enhance both adherence rates and confidence in managing blood glucose effectively.

An Assessment of Health Behaviours in Primary Care Patients: A Cross-Sectional Study

A healthy lifestyle is a key determinant of health, especially for people with chronic diseases such as diabetes or hypertension. The health behaviours which contribute to a healthy lifestyle include the following: regular physical activity, preventive examinations, maintaining a proper diet and avoiding the consumption of alcohol or cigarettes. They have a significant impact on the disease process, controlling symptoms and preventing complications. The aim of this study was to examine the health behaviours related to diet, physical activity and prevention among Polish primary health care patients and to identify predictors of health behaviours. For this reason, the standardized Health Behaviour Scale (HBS) questionnaire was used. The study was conducted among 269 patients (including 61.71% women) in primary health care facilities. The mean age of participants was 52.89 years (±17.76). The mean HBS score was 36.93 ± 9.66. A statistically significant association was found between HBS scores and such sociodemographic variables as education (p = 0.0061, r = 0.17), body mass index (p = 0.0018, r = -0.20, β = -0.36) and self-assessed economic status (p = 0.0094, r = 0.16). Women's health behaviours as measured by HBS were significantly better than men's (p < 0.001, β = -6.82). A special focus should be given to the groups manifesting poorer health behaviours (e.g., men, older people and persons with low socioeconomic status) by offering them tailored health-promoting interventions.

Sublingual immunotherapy adherence in patients with allergic rhinitis: Effects of an intervention based on the information-motivation-behavioral skills model

OBJECTIVE

This study aimed to confirm the efficacy of an intervention based on the information-motivation-behavior skills (IMB) model in improving the sublingual immunotherapy adherence score, medication beliefs score, self-efficacy score, and medication knowledge score of patients with allergic rhinitis.

METHODS

A total of 120 patients with allergic rhinitis from an otorhinolaryngology clinic were divided into the control group (n = 60) and experimental group (n = 60); the study was conducted from August 2021 to March 2022. The control group received routine intervention, whereas the experimental group received intervention based on the IMB model. The medication adherence, medication beliefs, self-efficacy, and medication knowledge levels of the two groups were evaluated at baseline, post-intervention, at 1-month follow-up, and at 3-month follow-up.

RESULTS

After intervention, a total of 116 patients completed the trial in the experimental and control groups (58 cases each). The results revealed differences in the scores of medication adherence, belief, self-efficacy, and knowledge between the two groups post-intervention, at 1-month follow-up, and at 3-month follow-up (P < 0.05). Further, the scores of the four indexes of the two groups were different with time, and better changes were noted among experimental group participants.

CONCLUSION

Implementing interventions based on the IMB model for people receiving sublingual immunotherapy for allergic rhinitis can effectively improve patients' medication beliefs, self-efficacy, and knowledge of medication, thereby improving their medication adherence, ensuring efficacy, and providing medication care for outpatients.

Factors associated with eating behaviors in older adults from a socioecological model perspective

BACKGROUND

The eating behaviors of older adults are associated with multiple factors. To promote older adults' healthy diets, it is imperative to comprehensively study the factors associated with the eating behaviors of the aging population group. This study aimed to probe the associated factors of older adults' eating behaviors from a socioecological model (SEM) perspective.

METHODS

In 2021, a cross-sectional survey was performed to recruit participants in China. The survey data were analyzed using a multivariate generalized linear model to identify the factors associated with eating behaviors in older adults. Standardized regression coefficients (β) and 95% confidence intervals (CIs) were estimated using a multivariate generalized linear model.

RESULTS

The survey contained 1147 valid older adult participants. Multivariate generalized linear model results showed that older adults with older age [aged 71-80 (β = -0.61), ≥ 81 (β = -1.12)], conscientiousness personality trait (β = -0.27), and higher family health levels (β = -0.23) were inclined to have better eating behaviors. The older adults with higher education levels [junior high school and high school (β = 1.03), junior college and above (β = 1.71)], higher general self-efficacy (β = 0.09), more severe depression symptoms (β = 0.24), and employment (β = 0.82) tended to have poorer eating behaviors.

CONCLUSIONS

This study identified factors that are specifically associated with older adults' eating behaviors from an SEM perspective. The comprehensive multiple-angle perspective consideration may be a valuable idea for studying healthy eating behaviors in older adults.

Improving goal striving and resilience in older adults through a personalized metacognitive self-help intervention: a protocol paper

BACKGROUND

Successful aging is often linked to individual's ability to demonstrate resilience: the maintenance or quick recovery of functional ability, well-being, and quality of life despite losses or adversity. A crucial element of resilience is behavioral adaptability, which refers to the adaptive changes in behavior in accordance with internal or external demands. Age-related degradation of executive functions can, however, lead to volition problems that compromise flexible adjustment of behavior. In contrast, the reliance on habitual control has been shown to remain relatively intact in later life and may therefore provide an expedient route to goal attainment among older adults. In the current study, we examine whether a metacognitive self-help intervention (MCSI), aimed at facilitating goal striving through the gradual automatization of efficient routines, could effectively support behavioral adaptability in favor of resilience among older adults with and without (sub-clinical) mental health problems.

METHODS

This metacognitive strategy draws on principles from health and social psychology, as well as clinical psychology, and incorporates elements of established behavioral change and activation techniques from both fields. Additionally, the intervention will be tailored to personal needs and challenges, recognizing the significant diversity that exist among aging individuals.

DISCUSSION

Despite some challenges that may limit the generalizability of the results, our MCSI program offers a promising means to empower older adults with tools and strategies to take control of their goals and challenges. This can promote autonomy and independent functioning, and thereby contribute to adaptability and resilience in later life.

TRIAL REGISTRATION

Pre-registered, partly retrospectively. This study was pre-registered before the major part of the data was collected, created, and realized. Only a small part of the data of some participants (comprising the baseline and other pre-intervention measures), and the full dataset of the first few participants, was collected prior to registration, but it was not accessed yet. See: https://osf.io/5b9xz.

A multi-country survey of the socio-demographic factors associated with adherence to COVID-19 preventive measures during the first wave of the COVID-19 pandemic

BACKGROUND

Health behaviours are influenced by individual characteristics including age, gender, education and economic level. This study aimed to assess the associations between individual-level determinants and adherence to COVID-19 preventive measures.

METHODS

We performed secondary analyses of international data collected using an online survey during the first wave of the COVID-19 pandemic between June and December 2020. The dependent variables were self-reported adherence to COVID-19 preventive measures (wearing of face masks, frequent washing/sanitizing of hands, physical distancing, working remotely). The independent variables were age, sex at birth (female vs male), having a chronic disease related elevated risk for severe COVID-19 (none/little, might be at increased risk, at increased risk), educational level completed (no formal education, primary, secondary vs college/university) and employment status (retiree, students, not employed vs employed). Four multivariate logistic regression analyses were conducted to determine the associations between the dependent variables and independent variables. Interaction terms with country-income level were tested in regressions to explore its moderating effect.

RESULTS

Out of 16,866 respondents, 12,634 (74.9%) wore masks or face coverings, 12,336 (73.1%) washed or sanitized their hands frequently, 11,464 (68.0%) reported adherence to physical distancing and 5,646 (33.5%) worked remotely. In adjusted analyses, increased age, college/university education, employment, and having risks for severe COVID-19 were associated with significantly higher odds of adhering to COVID-19 preventive measures. Retirees and students had lower odds of adhering to COVID-19 prevention measures than employed individuals. Males had significantly lower odds of wearing face masks (AOR: 0.901), frequent washing/sanitizing hands (AOR: 0.774) and working remotely (AOR: 0.875) compared to females. Country-income level generally moderated the above relationships such that the associations disappeared in lower income countries.

CONCLUSION

The study findings suggest that the individual socio-demographic factors-age, sex, employment status, education status and having a chronic disease - influence adherence to COVID-19 preventive measures. Findings further reiterate the need for health education and health promotion campaigns on preventive health measures to focus on subpopulations, such as younger males, students and retirees, that require targeted or unique messaging.