Identifying and addressing psychosocial determinants of adherence to physical distancing guidance during the COVID-19 pandemic - project protocol

What did we learn about changing behaviour during the COVID-19 pandemic? A systematic review of interventions to change hand hygiene and mask use behaviour

BACKGROUND

behaviour change interventions were central in the COVID-19 response and are vital for strengthening pandemic preparedness and resilience. To be effective, interventions must target specific behavioural determinants, but determinants are complex and multifaceted and there is a gap in robust, theory driven evidence on which behavioural determinants are most effective at changing mask usage and hand hygiene behaviour.

PURPOSE

to map available evidence on the types of hand hygiene and mask usage behaviour change interventions conducted during the COVID-19 pandemic and assess their effectiveness, feasibility and acceptability.

METHODS

we conducted a systematic review, searching four peer-reviewed databases for terms related to COVID-19, targeted behaviours (hand hygiene and mask usage) and interventions. Eligible studies were those which focused on adults or children in naturalistic, non-experimental settings; reported on an intervention designed to change hand hygiene and or mask usage to reduce COVID-19 transmission; provided clear outcome measures, including through self-report, proxy indicators or observation. Studies were excluded if they were purely qualitative, opinion pieces or based on secondary data alone; focused on health workers; measured intended rather than enacted behaviour; were conducted in laboratory or health care-based settings; involved infants; were published before the 11th of March 2020 (when COVID-19 was declared a pandemic) and published in a language other than English. There were no geographical limits set. Descriptive summaries were produced and the quality of evidence and reporting was evaluated. Studies were divided into three sub-groups according to the behaviour targeted and behaviour change techniques (BCTs) were mapped. Effect estimates were summarised and the relationship between BCTs and effect was explored. Feasibility and acceptability was summarised where reported. Due to the heterogeneity of studies included, meta-analysis could not be conducted.

FINDINGS

sixteen citations met the criteria, with sub-studies (two citations including multiple studies) totalling nineteen eligible studies. The majority were randomised controlled trials which targeted hand hygiene only and were conducted in high income nations, with none conducted in crisis settings. Due to the constraints of the pandemic, many interventions were delivered online. The quality of studies was low, with the majority demonstrating a medium risk of bias (Likert scale: low, medium, high). Whilst acceptability and feasibility was good, both were rarely evaluated. 'Natural consequences' was the most commonly used BCT group. Fourteen of the studies elicited positive or potentially positive effects in at least one intervention arm and/or targeted behaviour. Effective interventions typically targeted multiple individual BCTs, including 'Instruction on how to perform a behaviour', 'Information about health consequences', and group 'Reward and threat', through repeated engagement over a sustained period of time.

CONCLUSION

there is a substantial knowledge gap, particularly in low resource and crisis settings, and available evidence is of low quality. We must address these gaps to enable evidence-based practice and strengthen pandemic preparedness and resilience. Future research should include another systematic review which includes grey literature and different languages, as well as more robust evaluations which use implementation research to explore the impact of multiple BCTs in low resource and crisis settings. Evaluations should include assessments of acceptability, practicability, affordability and equity.

Cross-sectional survey of compliance behaviour, knowledge and attitudes among cases and close contacts during COVID-19 pandemic

Objectives

A key public health intervention is self-isolation for cases and restriction of movement for contacts. This study aimed to identify predictors of compliance behaviour and describe knowledge and attitudes among cases and contacts identified by the national Contact Management Programme to inform the global public health response.

Study design

Secondary data analysis of anonymised cross-sectional survey data on national sample of cases and close contacts.

Methods

A sample of 1000 cases and 1000 contacts was calculated to estimate compliance within a margin of error of 3% with 95% confidence. A telephone survey administered by trained interviewers collected information on socio-demographics, compliance behaviours, knowledge, and attitudes to COVID-19 from cases and close contacts. Data analysis included chi-squared statistics and multivariable logistic regression.

Results

Most cases and contacts complied with public health guidance with similar characteristics in those who did and did not comply. Reasons for non-compliance included exercise, medical appointment, shopping, and work. Cases and contacts reported high levels of understanding about symptoms of COVID-19 and satisfaction with available information.

Conclusion

Achieving high compliance with public health guidance is feasible and requires political leadership, policy changes and practical solutions.

Impact of biological sex and gender-related factors on public engagement in protective health behaviours during the COVID-19 pandemic: cross-sectional analyses from a global survey

OBJECTIVE

Given the role of sociocultural gender in shaping human behaviours, the main objective of this study was to examine whether sex and gender-related factors were associated with the public's adherence to COVID-19-recommended protective health behaviours.

DESIGN

This was a retrospective analysis of the survey that captured data on people's awareness, attitudes and behaviours as they relate to the COVID-19 policies.

SETTING

Data from the International COVID-19 Awareness and Responses Evaluation survey collected between March 2020 and February 2021 from 175 countries.

PARTICIPANTS

Convenience sample around the world.

MAIN OUTCOME MEASURES

We examined the role of sex and gender-related factors in relation to non-adherence of protective health behaviours including: (1) hand washing; (2) mask wearing; and (3) physical distancing. Multivariable logistic regression was conducted to determine the factors associated with non-adherence to behaviours.

RESULTS

Among 48 668 respondents (mean age: 43 years; 71% female), 98.3% adopted hand washing, 68.5% mask wearing and 76.9% physical distancing. Compared with males, females were more likely to adopt hand washing (OR=1.97, 95% CI: 1.71 to 2.28) and maintain physical distancing (OR=1.28, 95% CI: 1.22 to 1.34). However, in multivariable sex-stratified models, females in countries with higher Gender Inequality Indexes (GII) were less likely to report hand washing (adjusted OR (aOR)=0.47, 95% CI: 0.21 to 1.05). Females who reported being employed (aOR=0.22, 95% CI: 0.10 to 0.48) and in countries with low/medium GIIs (aOR=0.18, 95% CI 0.06 to 0.51) were less likely to report mask wearing. Females who reported being employed were less likely to report physical distancing (aOR=0.39, 95% CI: 0.32 to 0.49).

CONCLUSION

While females showed greater adherence to COVID-19 protective health behaviours, gender-related factors, including employment status and high country-wide gender inequality, were independently associated with non-adherence. These findings may inform public health and vaccination policies in current as well as future pandemics.

The Influence of Physical Distancing, Sense of Belonging, and Resilience of Nursing Students on Their Viral Anxiety During the COVID-19 Era

OBJECTIVE

We aimed to explore how nursing students' adherence to physical distancing, sense of belonging, or resilience may be associated with viral anxiety during the coronavirus disease (COVID-19) era in South Korea.

METHODS

We conducted an online survey among nursing students from December 8-10, 2021. The survey gathered participants' age, sex, grades, living area, and responses to questions on COVID-19. In addition, responses to Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), adherence to physical distancing, Sense of Belonging Instrument, Calling and Vocation Questionnaire, Patient Health Questionnaire-9 items (PHQ-9), and Connor-Davidson Resilience Scale-2 (CD-RISC2) items were gathered.

RESULTS

The SAVE-6 score was significantly correlated with adherence to physical distancing (r=0.29), PHQ-9 (r=0.26), and CD-RISC2 (r=-0.34, all p<0.01) similar to partial correlation analysis adjusting participants' group (freshmen and sophomores vs. juniors and seniors). A linear regression analysis revealed that viral anxiety of nursing students was predicted by sex (female, β=0.20, p=0.001), adherence to physical distancing (β=0.25, p<0.001), sense of belonging (β=0.16, p=0.014), and CD-RISC2 score (β=-0.32, p<0.001) (adjusted R2=0.24, F=10.01, p<0.001).

CONCLUSION

We observed that adherence to physical distancing, sense of belonging, and their resilience influenced nursing student's viral anxiety. An appropriate support system to manage viral anxiety is needed for nursing students during the COVID-19 pandemic.

Adherence to physical distancing guidance in Ireland: a nationally representative analysis from the International COVID-19 Awareness and Responses Evaluation (iCARE) study

Background: Physical distancing measures (i.e., limiting physical contact with people outside of one’s household, maintaining a 2-metre distance between oneself and others, avoiding non-essential travel, etc.) are among the primary strategies used to prevent transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). These measures will remain crucial during the rollout of newly developed vaccines to limit community-based spread of COVID-19 and prevent healthcare systems from becoming overburdened. Therefore, it is essential to understand the determinants of public adherence to physical distancing measures to inform current and future public health communications.   Methods: As part of the International COVID-19 Awareness and Responses Evaluation (iCARE) study, a cross-sectional survey was conducted to evaluate behavioural responses to physical distancing measures in Ireland. A nationally representative sample of 1000 adults completed the survey over one week in June 2020 during Phase 2 restrictions. Participants completed measures assessing socio-demographic characteristics, theory-based psychological predictors, and physical distancing behaviours. Results: Awareness of restrictions in place at the time of data collection was high overall, as was adherence to most physical distancing measures. Participants aged 25–34 years reported the poorest adherence to maintaining a 2-metre distance from others (71.2%, versus 79–90% for all other age groups), avoiding social gatherings (42.4%, versus 52–62%) and avoiding non-essential travel (63.9%, versus 69–79%). Females were slightly more adherent than were males to most measures. Adherence also varied according to participant beliefs and COVID-19 risk category. Conclusions: These results indicate that adherence to physical distancing guidelines varies depending on the behaviour in question as well as socio-demographic and psychological factors. Although some non-adherence was evident for all physical distancing behaviours, adherence was generally high. Future interventions to improve adherence to physical distancing measures should target individual-level determinants of adherence in tandem with effective public health interventions.