A guilt-free strategy increases self-reported non-compliance with COVID-19 preventive measures: Experimental evidence from 12 countries

Adherence to COVID-19 measures and the associated factors: evidence from a two-wave longitudinal study in Singapore

BACKGROUND

At the onset of the Coronavirus disease (COVID-19) pandemic when pharmaceutical interventions were not readily available, governments relied on public health mandates and social distancing measures to counter rising infection rates. In order to address the dearth of longitudinal studies, this study sought to identify factors associated with continued adherence to COVID-19 preventive behaviours in Singapore.

METHODS

Data were from a two-wave longitudinal cohort study; baseline study was conducted from May 2020 to June 2021 and follow-up study from October 2021 to September 2022. Participants (n = 858) were Singapore residents, aged 18 and above, and able to speak English, Chinese or Malay. Weighted multivariable logistic regressions were conducted to identify factors associated with adherence to the COVID-19 measures.

RESULTS

Adherence rates of 'avoid dining out', 'crowded places', 'people with flu symptoms' and 'small group gatherings' at baseline were 39.41%, 60.82%, 79.82%, and 44.82% respectively. All measures had a decrease in adherence rates across the two-waves. Older age groups were associated with greater adherence to 'avoid dining out' and 'avoid crowded places'. Having high trust in local public health experts was associated with greater adherence to 'avoid crowded places' and 'avoid people with flu symptoms'. Fear of family and friends getting infected with COVID-19 was associated with 'avoid dining out' and 'avoid crowded places'.

CONCLUSIONS

Soft interventions like nudges can be implemented at crowded places to remind the public of the ease of transmitting the virus to their loved ones. Increasing media presence of public health experts can be a viable alternative to improve adherence.

Adherence to non-pharmaceutical interventions following COVID-19 vaccination: a federated cohort study

In pandemic mitigation, strategies such as social distancing and mask-wearing are vital to prevent disease resurgence. Yet, monitoring adherence is challenging, as individuals might be reluctant to share behavioral data with public health authorities. To address this challenge and demonstrate a framework for conducting observational research with sensitive data in a privacy-conscious manner, we employ a privacy-centric epidemiological study design: the federated cohort. This approach leverages recent computational advances to allow for distributed participants to contribute to a prospective, observational research study while maintaining full control of their data. We apply this strategy here to explore pandemic intervention adherence patterns. Participants (n = 3808) were enrolled in our federated cohort via the "Google Health Studies" mobile application. Participants completed weekly surveys and contributed empirically measured mobility data from their Android devices between November 2020 to August 2021. Using federated analytics, differential privacy, and secure aggregation, we analyzed data in five 6-week periods, encompassing the pre- and post-vaccination phases. Our results showed that participants largely utilized non-pharmaceutical intervention strategies until they were fully vaccinated against COVID-19, except for individuals without plans to become vaccinated. Furthermore, this project offers a blueprint for conducting a federated cohort study and engaging in privacy-preserving research during a public health emergency.

Evaluation of a national program to distribute free face masks in Uganda: Evidence from Mbale District

BACKGROUND

COVID-19 posed a major threat to countries around the world, but many nations in sub-Saharan Africa avoided large-scale outbreaks. In Uganda, the government first enacted strict lockdowns but later focused on public health policies like masking and distancing. The government also embarked on an ambitious campaign to deliver a free face mask to all Ugandan citizens (approx. 30 million masks). We test whether mask distribution, and public education and encouragement of mask use by community health volunteers, affected mask behavior.

METHODS

We collected data about mask behavior before and after masks were distributed in the Mbale district of Uganda. Trained enumerators directly observed mask wearing in public places and asked about mask use via phone surveys. We compared observed and self-reported mask behavior before and after masks were distributed. We also tested whether training volunteers from randomly selected villages to educate the public about COVID-19 and masks affected behavior, attitudes, and knowledge among mask recipients.

RESULTS

We collected 6,381 direct observations of mask use at baseline (February 2021) and 19,855 observations at endline (April 2021). We conducted a listing of 9,410 households eligible for phone surveys and randomly selected 399 individuals (4.2%) at baseline and 640 (6.8%) at endline. Fewer than 1% of individuals were observed wearing masks at baseline: 0.9% were seen with a mask and 0.5% wore masks over mouth and nose. Mask wearing significantly increased at endline but remained low: 1.8% of people were observed with masks and 1.1% were seen wearing masks correctly after the distribution campaign. At the same time, a high proportion of people reported using masks: 63.0% of people reported using masks at baseline and 65.3% at endline when walking around their villages. When respondents were asked about mask use in public places, 94.7% reported using masks at baseline and 97.4% reported using masks at endline. We found no differences in knowledge, behavior, or attitudes among mask recipients in villages where volunteers were tasked with conveying information about COVID-19 and masks during distribution.

CONCLUSION

Mask use remained low in Mbale district of Uganda during study observation period even after free masks were distributed. Encouraging new health behaviors may need to involve more intensive interventions that include reminders and address social norms.

A SARS-CoV-2 outbreak investigation at a storage and distribution centre in England: an assessment of worker- and workplace-related risk factors

An outbreak of SARS-CoV-2 (1 March to 10 May 2021) with an attack rate of 26.5% among approximately 1150 workers at a storage and distribution centre in England prompted a multidisciplinary outbreak investigation (5 May to 6 August 2021), with the aim of better understanding worker- and workplace-related risk factors for viral transmission in the warehousing sector. Overall, environmental factors (e.g., ventilation, humidity and temperature) were assessed to be appropriate at the facility. Nevertheless, 39 (51.3%) surface samples from across the site tested positive for low/ very low levels of SARS-CoV-2 RNA (Ct value ≥ 32.0 for all). Among the study participants, of whom 35.6% were confirmed or suspected cases, 95.5% reported having received COVID-19 prevention training, 100.0% reported handwashing, and 80.0% reported use of face coverings at work. Notably, 43.9% and 19.0% reported working with a symptomatic and a positive contact respectively. Furthermore, 80.5% and 46.3% had concerns regarding reduction in their income and future unemployment, respectively, due to self-isolation. The findings of this study suggest that, in addition to targeted workplace infection control measures and tailored work area specific risk assessments, an enhanced and equitable sick leave policy may help limit presenteeism and viral transmission in large workplaces.

Exploring the role of our contacts with pets in broadening concerns for animals, nature, and fellow humans: a representative study

While pet ownership is normative in many occidental countries, whether humans' proximal contacts with pets have implications for attitudes and behaviors toward other (non pet) animals, nature, and fellow humans, has received limited empirical attention. In a large representative sample, we investigate whether pet ownership and positive contact with pets are associated with more positive attitudes and heightened concerns for non-pet animals, nature, and human outgroups. A cross-sectional questionnaire survey was conducted among Canadian adults (619 pet owners, 450 non-pet owners). Pet owners reported more positive attitudes toward non-pet animals (e.g., wild, farm animals), higher identification with animals, more positive attitudes toward human outgroups, higher biospheric environmental concerns, higher human-environment interdependence beliefs, and lower usual meat consumption. Positive contact with pets was also associated with most of these outcomes. Solidarity with animals, a dimension of identification with animals, emerged as a particularly clear predictor of these outcomes and mediated the associations between positive contact with pets and positive attitudes toward non-pet animals, biospheric, egoistic, and altruistic environmental concerns, human-environment interdependence beliefs, and diet. Our results provide support for the capacity of pets to shape human consideration for a broad range of social issues, beyond the specific context of human-pet relations.

Risk Perception and Public Pandemic Fatigue: The Role of Perceived Stress and Preventive Coping

Purpose

This study explores the status of pandemic fatigue, predictors, and their mechanisms of action based on a stress-response framework and a parallel model of future-oriented response.

Patients and methods

Study 1 investigated 8426 Chinese adult residents' understanding of and willingness to cooperate with the pandemic prevention and control policies and Study 2 surveyed 1635 Chinese residents on their activeness of pandemic prevention and control (APPC), pandemic risk perception, perceived stress, and future-oriented coping.

Results

Study 1 found that public understanding of and willingness to cooperate with prevention policies were significantly lower in 2022 than in 2020 and 2021. Study 2 found that risk perception negatively predicted the APPC; perceived stress and preventive coping significantly mediated the relationship between risk perception and APPC; but perceived stress and proactive coping did not significantly mediate the relationship between risk perception and APPC.

Conclusion

This revealed an increase in public fatigue in the third year of the pandemic. Pandemic fatigue can be predicted by pandemic risk perception, but the direct pathway of action is not significant and requires the mediation of perceived stress and preventive coping.

Communicating with ethnic minorities during COVID-19: An experimental test of the effect of self-, ingroup-, and intergroup-focused messages

Developing messaging to encourage minorities to adhere to health recommendations has been a complex task for governments worldwide during the COVID-19 crisis. Here, we propose and tests a new typology of messages among minorities that can be used to mobilize compliance and engagement. This typology comprises three messaging treatments emphasizing personal, ingroup, and intergroup benefits. We examine, via an experimental field study, whether there is a difference in the effect of these messages on two policy outcomes, social distancing and vaccine hesitancy, among the Arab minority living in Israel. The findings suggest that social messages, i.e., ingroup and intergroup messages, positively affect social distancing, while self-messaging harms social distancing compliance. Regarding vaccine intake, within the social messages tested, intergroup-focused messages were more effective than ingroup-focused messages for vaccination intentions only among citizens with low trust in the government. We discuss the findings in detail and propose new avenues in theory and practice to foster health policy compliance among minorities.

Unmasking the truth: Experimental evidence of facemask compliance in Bangladesh, Kenya, and Nigeria during the COVID-19 pandemic

High levels of compliance with public health measures are critical to ensure a successful response to the COVID-19 pandemic and other public health emergencies. However, most data on compliance are self-reported and the tendency to overreport due to social desirability could yield biased estimates of actual compliance. A list experiment is a widely used method to estimate social desirability bias in self-reported estimates of sensitive behaviours. We estimate rates of compliance with facemask mandates in Kenya, Nigeria, and Bangladesh using data from phone surveys conducted in March-April 2021. Data on compliance were collected from two different survey modules: a self-reported compliance module (stated) and a list experiment (elicited). We find large gaps between stated and elicited rates of facemask wearing for different groups depending on specific country contexts and high levels of overreporting of facemask compliance in self-reported surveys: there was an almost 40 percentage point gap in Kenya, 30 percentage points in Nigeria, and 20 percentage points in Bangladesh. We also observe differences in rates of self-reported facemask wearing among key groups but not using the elicited responses from the list experiment, which suggest that social desirability bias may vary by demographics. Data collected from self-reported surveys may not be reliable to monitor ongoing compliance with public health measures. Moreover, elicited compliance rates indicate levels of mask wearing are likely much lower than those estimated using self-reported data.

Happily Distant or Bitter Medicine? The Impact of Social Distancing Preferences, Behavior, and Emotional Costs on Subjective Wellbeing During the Epidemic

To inhibit the spread of COVID-19 Public health officials stress, and governments often require, restrictions on social interaction ("social distancing"). While the medical benefits are clear, important questions remain about these measures' downsides: How bitter is this medicine? Ten large non-probability internet-based surveys between April and November 2020, weighted statistically to reflect the US population in age, education, and religious background and excluding respondents who even occasionally role-played rather than giving their own true views; N = 6,223. Pre-epidemic data from 2017-2019, N = 4,032. Reliable multiple-item scales including subjective wellbeing (2 European Quality of Life Survey items, Cronbach's alpha = .85); distancing attitudes (5 items, alpha = .87); distancing behavior e.g., standing 6' apart in public (5 items, alpha = .80); emotional cost of distancing and restrictions on social interaction (8-12 items, alpha = .94); and an extensive suite of controls (19 variables). Descriptive statistics, OLS regression, structural equation models. Subjective wellbeing is greater for those who approve of distancing, for those who practice distancing, and particularly for those whose distancing attitudes and behavior are congruent, either both in favor or both opposed (multiplicative interaction). The emotional cost of distancing is strongly tied to wellbeing and is heterogeneous, with some disliking distancing much more than others. An SEM model suggests causality: that emotional costs strongly reduce wellbeing but not vice-versa. During the epidemic, COVID issues constitute two of the top 5 influences on wellbeing, behind only subjective health and religious belief and tied with income. All this is net of family background, religious origins, age, ethnicity, race, gender, rural residence, education, occupational status, marriage, unemployment, income, health, religion, and political party.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11482-023-10149-0.

Prospective sampling bias in COVID-19 recruitment methods: experimental evidence from a national randomized survey testing recruitment materials

BACKGROUND

In the context of the COVID-19 pandemic, social science research has required recruiting many prospective participants. Many researchers have explicitly taken advantage of widespread public interest in COVID-19 to advertise their studies. Leveraging this interest, however, risks creating unrepresentative samples due to differential interest in the topic. In this study, we investigate the design of survey recruitment materials with respect to the views of resultant participants.

METHODS

Within a pan-Canadian survey (stratified random mail sampling, n = 1969), the design of recruitment invitations to prospective respondents was experimentally varied, with some prospective respondents receiving COVID-specific recruitment messages and others receiving more general recruitment messages (described as research about health and health policy). All respondents participated, however, in the same survey, allowing comparison of both demographic and attitudinal features between these groups.

RESULTS

Respondents recruited via COVID-19 specific postcards were more likely to agree that COVID-19 is serious and believe that they were likely to contract COVID-19 compared to non-COVID respondents (odds = 0.71, p = 0.04; odds = 0.74, p = 0.03 respectively; comparing health to COVID-19 framed respondents). COVID-19 specific respondents were more likely to disagree that the COVID-19 threat was exaggerated compared to the non-COVID survey respondents (odds = 1.44, p = 0.02).

CONCLUSIONS

COVID-19 recruitment framing garnered a higher response rate, as well as a sample with greater concern about coronavirus risks and impacts than respondents who received more neutrally framed recruitment materials.

The school education, ritual customs, and reciprocity associated with self-regulating hand hygiene practices during COVID-19 in Japan

Background

The role of social ties, other-regarding preferences, and cultural traits in boosting community resilience and minimizing citizens’ vulnerability to crises such as COVID-19 is increasingly being recognized. However, little is presently known about the possible routes through which such personal preferences and cultural norms pertinent to social behaviors are formulated. Thus, in this paper, factors that can be potentially associated with individuals to self-regulate strict hand hygiene practices before the pandemic, during the state of emergency, and after the state of emergency was lifted in Japan are investigated. Focus is given to the handwashing education in primary school, a cultural practice originating from the old Shinto tradition, and individuals’ reciprocal inclinations. As people in Japan are known to be highly conscious of hygiene in all aspects of their daily life and are less likely to contract an infection, evidence obtained in this specific context could contribute to the better understanding of individuals’ health-related behaviors in general, and during crises in particular.

Methods

Using the data derived from a four-wave nationwide longitudinal online survey, we examined the extent to which elementary school education, childhood cultural experiences at shrines, and individual other-regarding preferences are associated with self-regulating hand hygiene practices prior to the pandemic and people’s efforts to comply with the government-imposed measures aimed at preventing the spread of COVID-19 infection during the state of emergency. We also investigated the long-term trends in the relationships among these factors (i.e., after the abolishment of the state of emergency) using panel data.

Results

Our findings reveal that childhood education and cultural experiences related to handwashing practices, as well as reciprocal inclinations, are significantly associated with Japanese attitudes toward personal hygiene (beyond handwashing practices) prior to, during, and after the state of emergency. In recognition of the possible effects of recall bias and measurement errors, several important attempts to mitigate these issues were made to strengthen the value of our findings.

Conclusions

The importance of school education received during childhood, as well as culture and other-regarding preferences, in the individual attitudes toward hand hygiene in adulthood highlighted in this study contributes to the better understanding of the role that these factors play in the variations in voluntary compliance with strict hand hygiene practices before and during an uncertain and prolonged crisis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14012-z.

Community mask wearing as a COVID-19 preventive measure, its barriers, and motivators among rural households of Uganda: A mixed methods approach

Adherence to mask wearing has the potential to reduce coronavirus disease 2019 acquisition risk. However, there is limited information about community mask wearing and its predictors among rural populations. This study aimed to assess the level of adherence to community mask wearing as a COVID-19 prevention measure, its barriers, and motivators among the Ugandan rural population of Wakiso District. This cross-sectional study utilised both quantitative and qualitative data collection methods. The quantitative component employed a semi-structured interviewer-administered questionnaire among 400 participants, to assess the level of adherence and associated predictors towards mask wearing. Modified Poisson regression with robust standard error estimates was used to obtain crude and adjusted prevalence ratios associated with mask wearing. Quantitative data analysis was performed using Stata 15.0 Statistical software. The qualitative component was used to further explore the barriers and motivators of community mask wearing whereseven focus group discussions among 56 community health workers were conducted. Data was analysed using a thematic approach with the help of Nvivo Version 12 software. The quantitative results showed that 70.8% (283/400) of the participants were adherent to mask wearing. Furthermore, reusable (cloth masks) were the most common form of face masks worn by the participants; 71.9% (282/400). Adequate knowledge about mask wearing as a COVID-19 prevention measure was positively associated with mask wearing (adjusted prevalence ratio (95% CI); 3.2 (1.19-8.56)). The qualitative results revealed; sensitization from health workers, provision of free masks, and fear of fines and arrests as motivators to mask wearing. Barriers to mask wearing included: inability to buy masks due to financial constraints, one-time provision of free masks, ill-fitting and worn-out masks, discomfort, and bribery. The practice of community mask wearing was sub-optimal among the study rural communities. Initiatives to scale up the practice need to be feasible for rural communities.

Which vaccine attributes foster vaccine uptake? A cross-country conjoint experiment

Why do people prefer one particular COVID-19 vaccine over another? We conducted a pre-registered conjoint experiment (n = 5,432) in France, Germany, and Sweden in which respondents rated the favorability of and chose between pairs of hypothetical COVID-19 vaccines. Differences in effectiveness and the prevalence of side-effects had the largest effects on vaccine preferences. Factors with smaller effects include country of origin (respondents are less favorable to vaccines of Chinese and Russian origin), and vaccine technology (respondents exhibited a small preference for hypothetical mRNA vaccines). The general public also exhibits sensitivity to additional factors (e.g. how expensive the vaccines are). Our data show that vaccine attributes are more important for vaccine preferences among those with higher vaccine favorability and higher risk tolerance. In our conjoint design, vaccine attributes–including effectiveness and side-effect prevalence–appear to have more muted effects among the most vaccine hesitant respondents. The prevalence of side-effects, effectiveness, country of origin and vaccine technology (e.g., mRNA vaccines) determine vaccine acceptance, but they matter little among the vaccine hesitant. Vaccine hesitant people do not find a vaccine more attractive even if it has the most favorable attributes. While the communication of vaccine attributes is important, it is unlikely to convince those who are most vaccine hesitant to get vaccinated.

Factors Influencing Compliance with COVID-19 Health Measures: A Spanish Study to Improve Adherence Campaigns

Since the spread of the COVID-19 virus was declared a pandemic, different measures have been taken to control it, including frequent hand-washing, the use of face masks and social distancing. Given the importance of these measures, the present study aims to assess compliance with them in a Spanish sample of 722 people aged between 18 and 65 years. It also aims to determine which factors influence the levels of compliance observed. Participants complied more with the rules in the public spaces. The younger group had lower levels of compliance than the older group. No differences were found in accordance with sex. It was shown that overall, the agents that most influenced compliance were family, testimonials and friends and fines. Some differences were observed in relation to age, and significant sex differences were found in some of these factors, with women scoring higher than men. The results are discussed in terms of their usefulness for the design of information campaigns that seek to foster a greater degree of engagement by the entire population and, ultimately, greater control of the pandemic, in addition to serving as a basis for the early prevention of the spread of new viruses in the future.

Pet ownership and psychological well-being during the COVID-19 pandemic

The question of pet ownership contributing to human well-being has received mixed empirical evidence. This contrasts with the lay intuition that pet ownership contributes positively to wellness. In a large representative sample, we investigate the differences that may exist between pet vs. non-pet owners in terms of their well-being during the COVID-19 pandemic, and examine among different sociodemographic strata, for whom pet ownership can be more vs. less beneficial. A cross-sectional questionnaire survey was conducted among Canadian adults (1220 pet owners, 1204 non-pet owners). Pet owners reported lower well-being than non-pet owners on a majority of well-being indicators; this general pet ownership effect held when accounting for pet species (dogs, cats, other species) and number of pets owned. Compared to owners of other pets, dog owners reported higher well-being. When examining the effect of pet ownership within different socioeconomic strata, being a pet owner was associated with lower well-being among: women; people who have 2 + children living at home; people who are unemployed. Our results offer a counterpoint to popular beliefs emphasising the benefits of pets to human wellness during the COVID-19 pandemic and confirm the importance of accounting for sociodemographic factors to further understand the experience of pet ownership.

Predicting willingness to be vaccinated for Covid-19: Evidence from New Zealand

Governments around the world are seeking to slow the spread of Covid-19 and reduce hospitalisations by encouraging mass vaccinations for Covid-19. The success of this policy depends on most of the population accepting the vaccine and then being vaccinated. Understanding and predicting the motivation of individuals to be vaccinated is, therefore, critical in assessing the likely effectiveness of a mass vaccination programme in slowing the spread of the virus. In this paper we draw on the I3 Response Framework to understand and predict the willingness of New Zealanders to be vaccinated for Covid-19. The Framework differs from most studies predicting willingness to be vaccinated because it is based on the idea that the willingness to adopt a behaviour depends on both involvement (a measure of motivational strength) with the behaviour and attitudes towards the behaviour. We show that predictions of individuals' willingness to be vaccinated are improved using involvement and attitudes together, compared to attitudes alone. This result has important implications for the implementation of mass vaccination programmes for Covid-19.

Concerns and coping mechanisms during the first national COVID-19 lockdown: an online prospective study in Portugal

Objectives

Study design

Methods

Results

Conclusions

'Citizens' Attitudes Under Covid19', a cross-country panel survey of public opinion in 11 advanced democracies

This article introduces data collected in the Citizens’ Attitudes Under Covid-19 Project (CAUCP), which surveyed public opinion throughout the Covid-19 pandemic in 11 democracies between March and December 2020. In this paper, we present a unique cross-country panel survey of citizens’ attitudes and behaviors during a worldwide unprecedented health, governance, and economic crisis. This dataset investigates the behavioral and attitudinal consequences of multifaceted Covid19 crisis across time and contexts. In this paper, we describe the design of the CAUCP and the descriptive features of the dataset; we also present promising research prospects.

Measurement(s)	Public Opinoin
Technology Type(s)	Individual-level survey

Is the Unequal COVID-19 Burden in Canada Due to Unequal Levels of Citizen Discipline across Provinces?

The unequal burden of the coronavirus disease 2019 (COVID-19) crisis (e.g., in terms of infection and death rates) across Canadian provinces is important and puzzling. Some have speculated that differences in levels of citizen compliance with public health preventive measures are central to understanding cross-provincial differences in pandemic-related health outcomes. However, no systematic empirical test of this hypothesis has been conducted. In this research, we make use of an exceptionally large dataset that includes 23 survey waves (N = 22,610) fielded in Canada across 12 months (April 2020-April 2021) to answer the question "Is there evidence of substantial cross-provincial differences in citizen compliance with basic public health measures designed to prevent the spread of infection?" We find that regional differences in self-reported behaviour are few and very modest, suggesting that interprovincial differences in COVID-19-related health outcomes have little to do with differences in citizen compliance, at least in the first year of the pandemic. These results have important implications. Although it is crucial that we continue to study regional variations related to the COVID-19 burden, public health agency officials, pundits, and politicians should be cautious when musing about the role of citizen compliance as the primary explanation of interprovincial pandemic health outcomes.

Compliance with Covid-19 measures: Evidence from New Zealand

Governments around the world are seeking to slow the spread of Covid-19 by implementing measures that encourage, or mandate, changes in people's behaviour. These changes include the wearing of face masks, social distancing, and testing and self-isolating when unwell. The success of these measures depends on the commitment of individuals to change their behaviour accordingly. Understanding and predicting the motivation of individuals to change their behaviour is therefore critical in assessing the likely effectiveness of these measures in slowing the spread of the virus. In this paper we draw on a novel framework, the I3 Compliance Response Framework, to understand and predict the motivation of residents in Auckland, New Zealand, to comply with measures to prevent the spread of Covid-19. The Framework is based on two concepts. The first uses the involvement construct to predict the motivation of individuals to comply. The second separates the influence of the policy measure from the influence of the policy outcome on the motivation of individuals to comply. In short, the Framework differentiates between the strength of individuals' motivation and their beliefs about the advantages and disadvantages of policy outcomes and policy measures. We found this differentiation was useful in predicting an individual's possible behavioural responses to a measure and discuss how it could assist government agencies to develop strategies to enhance compliance.

"Until I Know It's Safe for Me": The Role of Timing in COVID-19 Vaccine Decision-Making and Vaccine Hesitancy

Managing the COVID-19 pandemic-and other communicable diseases-involves broad societal uptake of vaccines. As has been demonstrated, however, vaccine uptake is often uneven and incomplete across populations. This is a substantial challenge that must be addressed by public health efforts. To this point, significant research has focused on demographic and attitudinal correlates with vaccine hesitancy to understand uptake patterns. In this study, however, we advance understandings of individual decision-making processes involved in vaccine uptake through a mixed-methods investigation of the role of timing in COVID-19 vaccine choices. In the first step, a survey experiment, we find the timing of vaccine rollout (i.e., when a vaccine becomes available to the respondent) has a significant impact on public decision-making. Not only is there a higher level of acceptance when the vaccine becomes available at a later time, but delayed availability is correlated with both lower levels of 'desire to wait' and 'total rejection' of the vaccine. In a second step, we explore associated qualitative data, finding that temporal expressions (i.e., professing a desire to wait) can serve as a proxy for underlying non-temporal rationales, like concerns around safety, efficacy, personal situations, or altruism. By identifying these patterns, as well as the complexities of underlying factors, through a mixed-methods investigation, we can inform better vaccine-related policy and public messaging, as well as enhance our understanding of how individuals make decisions about vaccines in the context of COVID-19.

Trust in scientists in times of pandemic: Panel evidence from 12 countries

This article analyzes the specific and critical role of trust in scientists on both the support for and compliance with nonpharmaceutical interventions (NPIs) during the COVID-19 pandemic. We exploit large-scale, longitudinal, and representative surveys for 12 countries over the period from March to December 2020, and we complement the analysis with experimental data. We find that trust in scientists is the key driving force behind individual support for and compliance with NPIs and for favorable attitudes toward vaccination. The effect of trust in government is more ambiguous and tends to diminish support for and compliance with NPIs in countries where the recommendations from scientists and the government were not aligned. Trust in others also has seemingly paradoxical effects: in countries where social trust is high, the support for NPIs is low due to higher expectations that others will voluntary social distance. Our individual-level longitudinal data also allows us to evaluate the effects of within-person changes in trust over the pandemic: we show that trust levels and, in particular, trust in scientists have changed dramatically for individuals and within countries, with important subsequent effects on compliant behavior and support for NPIs. Such findings point out the challenging but critical need to maintain trust in scientists during a lasting pandemic that strains citizens and governments.

The health-economy trade-off during the Covid-19 pandemic: Communication matters

How do people balance concerns for general health and economic outcomes during a pandemic? And, how does the communication of this trade-off affect individual preferences? We address these questions using a field experiment involving around 2000 students enrolled in a large university in Italy. We design four treatments where the trade-off is communicated using different combinations of a positive framing that focuses on protective strategies and a negative framing which refers to potential costs. We find that positive framing on the health side induces students to give greater relevance to the health dimension. The effect is sizeable and highly effective among many different audiences, especially females. Importantly, this triggers a higher level of intention to adhere to social distancing and precautionary behaviors. Moreover, irrespective of the framing, we find a large heterogeneity in students' preferences over the trade-off. Economics students and students who have directly experienced the economic impact of the pandemic are found to give greater value to economic outcomes.

A multi-national test on self-reported compliance with COVID-19 public health measures: The role of individual age and gender demographics and countries' developmental status

Rationale/objective

The COVID-19 pandemic has brought far-reaching consequences on individual and societal levels. Social distancing and physical hygiene constitute effective public health measures to limit the spread of the virus. This study investigated age and gender demographics, in tandem with national levels of human development, as crucial factors influencing self-reported compliance with COVID-19-related public health measures.

Methods

The present study leveraged a large multi-national sample that ranged across the adult lifespan (18–100 years) and comprised 45,772 women and men from 66 countries/territories. Data were collected in Spring (2020) during the earlier phase of the COVID-19 pandemic. Self-reports of compliance with two public health measures (spatial distancing and physical hygiene) were assessed via online survey. Human Development Index (HDI), developed by the United Nations Development Program, was used as a proxy of a country's achievement in key dimensions of human development.

Results

Older age, female gender, and lower HDI were independently associated with greater self-reported compliance. A significant three-way interaction further revealed that self-reported compliance was lowest in young males from well-developed countries, while highest among females across all ages from less-developed countries.

Conclusion

The study offers an integration of individual-level and country-level demographic predictors of self-reported compliance and allows for robust testing in a large multi-national adult lifespan sample for enhanced generalizability. The results highlight the potential of data-driven, tailored (i.e., towards specific demographics, countries) health campaigns and public policies in the fight against a global pandemic.

The role of race and scientific trust on support for COVID-19 social distancing measures in the United States

Pundits and academics across disciplines note that the human toll brought forth by the novel coronavirus (COVID-19) pandemic in the United States (U.S.) is fundamentally unequal for communities of color. Standing literature on public health posits that one of the chief predictors of racial disparity in health outcomes is a lack of institutional trust among minority communities. Furthermore, in our own county-level analysis from the U.S., we find that counties with higher percentages of Black and Hispanic residents have had vastly higher cumulative deaths from COVID-19. In light of this standing literature and our own analysis, it is critical to better understand how to mitigate or prevent these unequal outcomes for any future pandemic or public health emergency. Therefore, we assess the claim that raising institutional trust, primarily scientific trust, is key to mitigating these racial inequities. Leveraging a new, pre-pandemic measure of scientific trust, we find that trust in science, unlike trust in politicians or the media, significantly raises support for COVID-19 social distancing policies across racial lines. Our findings suggest that increasing scientific trust is essential to garnering support for public health policies that lessen the severity of the current, and potentially a future, pandemic.

Differences in the Protection Motivation Theory Constructs between People with Various Latent Classes of Motivation for Vaccination and Preventive Behaviors against COVID-19 in Taiwan

The present study aimed to identify the distinct classes of motivations to get vaccinated and to adopt preventive behaviors against the coronavirus disease 2019 (COVID-19) among people in Taiwan and to examine the roles of Protection Motivation Theory (PMT) cognitive constructs in these unique classes of motivations to get vaccinated and to adopt preventive behaviors. We recruited 1047 participants by using a Facebook advertisement. Participants’ motivations to get vaccinated and to adopt preventive behaviors against COVID-19, PMT constructs of threat appraisal (perceived severity and perceived vulnerability), and PMT constructs of coping appraisal (self-efficacy, response efficacy, response cost, knowledge, and previous vaccination for seasonal influenza) were determined. We analyzed participants’ motivations to get vaccinated and to adopt preventive behaviors against COVID-19 by using latent profile analysis. The present study identified three latent classes, including the participants with high motivation for vaccination and preventive behaviors (the class of Both High), those with low motivation for vaccination and preventive behaviors (the class of Both Low), and those with high motivation for vaccination but low motivation for preventive behaviors (the class of High Vaccination but Low Preventive Behaviors). Compared with the participants in the class of Both High, participants in the class of Both Low had lower levels of perceived vulnerability, perceived severity, self-efficacy to have vaccination, response efficacy of vaccination, knowledge about vaccination, and previous vaccination for seasonal influenza; participants in the class of High Vaccination but Low Preventive Behaviors had lower levels of perceived vulnerability and perceived severity but higher levels of response cost of vaccination. We concluded that varieties of motivations, threat, and coping appraisals should be considered in intervention programs aiming to increase motivation to adopt recommended protective behaviors against COVID-19.

What containment strategy leads us through the pandemic crisis? An empirical analysis of the measures against the COVID-19 pandemic

Since January 2020, the COVID-19 outbreak has been progressing at a rapid pace. To keep the pandemic at bay, countries have implemented various measures to interrupt the transmission of the virus from person to person and prevent an overload of their health systems. We analyze the impact of these measures implemented against the COVID-19 pandemic by using a sample of 68 countries, Puerto Rico and the 50 federal states of the United States of America, four federal states of Australia, and eight federal states of Canada, involving 6,941 daily observations. We show that measures are essential for containing the spread of the COVID-19 pandemic. After controlling for daily COVID-19 tests, we find evidence to suggest that school closures, shut-downs of non-essential business, mass gathering bans, travel restrictions in and out of risk areas, national border closures and/or complete entry bans, and nationwide curfews decrease the growth rate of the coronavirus and thus the peak of daily confirmed cases. We also find evidence to suggest that combinations of these measures decrease the daily growth rate at a level outweighing that of individual measures. Consequently, and despite extensive vaccinations, we contend that the implemented measures help contain the spread of the COVID-19 pandemic and ease the overstressed capacity of the healthcare systems.