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

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.

Viral Anxiety Mediates the Influence of Intolerance of Uncertainty on Adherence to Physical Distancing Among Healthcare Workers in COVID-19 Pandemic

INTRODUCTION

The aims of this study were to examine the mediation effect of viral anxiety of healthcare workers on the influence of their intolerance of uncertainty on the adherence to physical distancing during the COVID-19 pandemic.

METHODS

An online survey was conducted among 329 healthcare workers (female: 81.4%, nursing professionals: 59.0%, and shift workers: 22.3%) on November 29, 2021. Participants responded to questionnaires on adherence to physical distancing, health beliefs, and perceived social norms, and rating scales of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), Patient Health Questionnaire-9 items (PHQ-9), and the Intolerance of Uncertainty-12 items (IUS-12) scale.

RESULTS

Adherence to physical distancing of healthcare workers was predicted by perceived benefits of physical distancing (β = 0.13, p = 0.01), personal injunctive norms (β = 0.32, p < 0.001), SAVE-6 score (β = 0.13, p = 0.02), and IUS-12 score (β = 0.10, p = 0.045) (adjusted R² = 0.21, F = 22.3, p < 0.001). Viral anxiety mediated the association between intolerance of uncertainty and adherence to physical distancing but not the influence of perceived benefits and personal injunctive norms on adherence to physical distancing.

CONCLUSION

We observed that viral anxiety of healthcare workers mediated the association between intolerance of uncertainty and adherence to physical distancing. During this pandemic, exploring adherence to physical distancing and its predicting factors will be helpful for the safety of healthcare workers and the patients for whom they care.

Exploring barriers and facilitators of physical distancing in the context of the COVID-19 pandemic: a qualitative interview study

Background: Physical distancing measures (e.g., keeping a distance of two metres from others, avoiding crowded areas, and reducing the number of close physical contacts) continue to be among the most important preventative measures used to reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19). Therefore, it is important to understand barriers and facilitators of physical distancing to help inform future public health campaigns. Methods: The current study aimed to qualitatively explore barriers and facilitators of physical distancing in the context of the COVID-19 pandemic using a qualitative interpretative design. Semi-structured one-to-one phone interviews were conducted with 25 participants aged 18+ years and living in the Republic of Ireland between September and October 2020. A purposive sampling strategy was used to maximise diversity in terms of age, gender, and socioeconomic status. Interviews were analysed using inductive thematic analysis. Results: Analysis resulted in the development of six main themes related to barriers and facilitators of physical distancing: (1) Maintaining and negotiating close relationships; (2) Public environments support or discourage physical distancing; (3) Habituation to threat; (4) Taking risks to protect well-being; (5) Personal responsibility to control the "controllables"; and (6) Confusion and uncertainty around government guidelines. Conclusions: Physical distancing measures were judged to be more or less difficult based on a number of internal and external psychosocial factors. Barriers to distancing included difficulties maintaining and negotiating close relationships, habituation to COVID-19-related threat, risk compensation, and confusion and uncertainty around government guidelines. Having a sense of personal responsibility to prevent COVID-19 transmission through distancing was an important facilitator. The structure of public environments was viewed as both barrier and facilitator. Barriers and facilitators may vary depending on context and life stage, which should be considered in the design of interventions to target physical distancing behaviour.

Content analysis of behaviour change techniques in government physical distancing communications for the reopening of schools during the COVID-19 pandemic in Ireland

Background: Effective government communications and leadership are central to the management of pandemics. Behavioural science can offer important insight into the development of such communications strategies. The extent to which established behaviour-change science is reflected in current government messaging campaigns to promote adherence to physical distancing measures in the context of the coronavirus disease 2019 (COVID-19) pandemic is unclear. The current study aimed to describe the behaviour-change content of a set of government-issued poster communications for the reopening of schools in Ireland during the COVID-19 pandemic in September 2020. Methods: Posters targeting physical distancing behaviours in school settings were retrieved from the Government of Ireland website for analysis. Posters were independently coded for behaviour change techniques (BCTs) using the BCT Taxonomy Version 1, a hierarchically clustered taxonomy of 93 distinct BCTs across 16 groups. The Theories and Techniques tool was used to identify mechanisms of action (MoAs) linked to each of the identified BCTs. Eight posters were independently content-analysed by two members of the research team for BCTs and linked MoAs. Results: Eight unique BCTs from six unique groups were identified in at least one poster. These BCTs were linked with 11 unique MoAs through which behaviour change is theorised to occur. Several theoretically important groups of BCTs, such as Natural Consequences, Social Support, Shaping Knowledge, and Comparison of Behaviour, were underutilised or not included in any of the posters. Conclusion: Future poster communications could benefit from including additional BCTs from key groups, particularly Natural Consequences. This article provides proof-of-concept evidence for future evaluations of government public health communications for behaviour-change content using existing taxonomies and tools.

Exploring barriers and facilitators of physical distancing in the context of the COVID-19 pandemic: a qualitative interview study

Background: Physical distancing measures (e.g., keeping a distance of two metres from others, avoiding crowded areas, and reducing the number of close physical contacts) continue to be among the most important preventative measures used to reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID -19). Therefore, it is important to understand barriers and facilitators of physical distancing to help inform future public health campaigns. Methods: The current study aimed to qualitatively explore barriers and facilitators of physical distancing in the context of the COVID-19 pandemic using a qualitative interpretative design. Semi-structured one-to-one phone interviews were conducted with 25 participants aged 18+ years and living in the Republic of Ireland between September and October 2020. A purposive sampling strategy was used to maximise diversity in terms of age, gender, and socioeconomic status. Interviews were transcribed verbatim and analysed using inductive thematic analysis. Results: Analysis resulted in the development of six main themes related to barriers and facilitators of physical distancing: (1) Maintaining and negotiating close relationships; (2) Public environments support or discourage physical distancing; (3) Habituation to threat; (4) Taking risks to maintain well-being; (5) Personal responsibility to control the “controllables”; and (6) Confusion and uncertainty around government guidelines. Conclusions: Our study found that physical distancing measures are judged to be more or less difficult based on a number of internal and external psychosocial factors, including maintaining and negotiating close relationships, habituation to threat, risk compensation, structure of public environments, personal responsibility, and confusion or uncertainty around government guidelines. Given the diversity in our sample, it is clear that the identified barriers and facilitators vary depending on context and life stage. Messaging that targets sub-groups of the population may benefit from considering the identified themes in this analysis.