The COSMO-Spain Survey: Three First Rounds of the WHO Behavioral Insights Tool

Assessment of Long-Term Changes in Knowledge and Attitudes of Household Contacts of COVID-19 Cases in Northern Spain

This study aims to describe the long-term changes in the knowledge of, and attitudes towards, COVID-19 and its preventive measures in northern Spain. A telephonic survey was performed among household contacts of COVID-19 cases in Catalonia and Navarre between May 2022 and December 2023. Knowledge and attitudes were assessed through 12 questions using a Likert scale, and responses were grouped as correct or incorrect. The change from baseline to the 6-month follow-up was evaluated with the absolute difference (AD) using the proportion of correct answers. At baseline, 299 subjects were contacted, of whom 63.2% (189) completed the 6-month follow-up. Correct knowledge of transmission (>85%) and the use of preventive measures (>92%) were observed at baseline and maintained over time. The attitudes towards face mask use remained adequate over the course of six months (>79%). However, attitudes regarding the use of face masks indoors (AD = -16.4%; p < 0.001) and those who thought that COVID-19 had a negative impact on their lives (AD = -16.5%; p < 0.001) decreased after 6 months. In the post-acute phase of the pandemic, household contacts maintained the correct level of knowledge towards COVID-19, while some attitudes decreased. These results should serve as a guide for health policy makers in decision-making in case of a new increase in the incidence of SARS-CoV-2.

Predictors of adherence in Austrian employees during the COVID-19 pandemic: results of an online survey

Background

Since the beginning of the pandemic in December 2019, Coronavirus disease 2019 (COVID-19) has been a significant challenge to health care systems throughout the world. The introduction of measures to reduce the incidence of infection had a significant impact on the workplace. Overall, companies played a key and adaptive role in coping with the pandemic.

Methods

Cross-sectional data from an online-survey of 1,183 employees conducted during the COVID-19 pandemic in spring 2021 in Austria were used in the analyses. The influence of health beliefs (e.g., perceived severity), modifying factors (e.g., age) and time-dependent factors (e.g., corona fatigue) on individual adherence were evaluated. The conception of the questionnaire was based on the health belief model.

Results

The majority of respondents were female (58.3%), worked in companies with more than 250 employees (56.6%) and had been to an academic secondary school or had a university degree (58.3%). Overall, employees were adherent to most of the measures at their company (>80%), except for wearing FFP-2 masks when they were travelling in a car with coworkers (59.3, 95%CI 51.3-66.7%). Overall adherence was associated with high ratings for the meaningfulness of testing (OR: 2.06 95%CI: 1.00-4.22; p = 0.049), the extent to which social norms govern behavior (OR: 6.61 95%CI: 4.66-9.36; p < 0.001), lower perceived difficulties associated with the adoption of health-promoting measures (OR: 0.37 95%CI: 0.16-0.82; p = 0.015) and lower corona fatigue (OR: 0.23 95%CI: 0.10-0.52; p < 0.001). Adherence to four single measures was influenced by different predictors. The most important predictors (important for the adherence to three out of four single measures) were social norms and corona fatigue.

Conclusion

The importance attached to testing and social norms, as well as lower perceived barriers to health-promoting measures and low levels of corona fatigue all increase overall adherence to Covid-19 protective measures in companies. Strategies to improve adherence should be adapted depending on the aim (to raise overall adherence or adherence to individual measures) and on the group of persons that is being targeted.

Associated factors for fear of COVID-19 scale in long-term care settings in Spain

OBJECTIVE

To examine the relationship between the Fear of COVID-19 Scale (FCV-19S) score and sociodemographic, health, emotional and behavioural factors, in a cross-sectional observational study in 447 older adults living in long-term care (LTC) settings in Madrid (Spain).

METHODS

The sample was stratified by nursing home ownership, geographical location, and size. Multiple linear regression analysis was used using backward elimination to identify factors that explained associations with fear, and logistic regression models were used to examine its role as a predictor of adherence to preventive measures.

RESULTS

The mean age of the participants was 83.8 years, most were female, had had COVID-19, and were worried about the pandemic. The average score of the FCV-19S was 18.36 (SD: 8.28; range: 7-35), and the variables associated in the multiple linear regression model (explained variance: 34.00%) were being female, lower level of education, satisfaction with life and the residential home, and higher worry about the pandemic. The logistic regression models showed that fear of COVID-19 was a predictor of adherence to preventive measures like wearing facemasks, washing hands, and avoiding physical contact.

CONCLUSIONS

fear of COVID-19 was significantly related with sex and subjective factors as life satisfaction and worry; and it influences older people's preventive behaviour. Interventions aimed at reducing fear and promoting adherence to preventive measures would improve their mental health and well-being.

Absence of short-term changes in knowledge and attitudes among household contacts of COVID-19 cases during the post-acute phase of the pandemic in Catalonia and Navarre, Spain

Objectives

To evaluate short-term changes in knowledge and attitude towards COVID-19 and preventive measures during the post-acute phase of the pandemic in Spain.

Methods

A survey was performed in Catalonia and Navarre between May-2022 and July-2023 in household contacts of COVID-19 cases. Knowledge and attitude were assessed at baseline and at three months, using a Likert scale. Responses were grouped according to correct or incorrect.

Results

At baseline, 172 subjects were contacted, 118 (69%) of which completed a follow-up interview three months later. Knowledge of correct hand-washing and mask protocols had maintained over time (-1.7%, p = 0.553 and - 2.5%, p = 0.473, respectively). Attitudes toward preventive measures was adequate in the first interview (86%), but attitudes regarding use of face masks decreased significantly (-9.1%, p = 0.048) over time in participants with higher risk of severe COVID-19. However, most short-term changes in knowledge and attitudes were not statistically significant.

Conclusion

Household contacts showed correct knowledge and attitude towards COVID-19 and its preventive measures, without significant changes in the short term despite a relaxation of government-mandated preventive measures. These results provide relevant information in case of a new health emergency due to respiratory viruses.

Preventive behavior against SARS-CoV-2 infection in adults according to whether or not they live with children. A combined analysis of the nationwide COSMO-SPAIN and ENE-COVID surveys

Introduction

The protection of children is a major driver of behavior among those in charge of their care. We evaluated whether compliance with preventive measures against SARS-CoV-2 infection among adults living with children was different from that of those not living with them, in 2020.

Methods

We used the COSMO-SPAIN (N = 867) and the nationally representative ENE-COVID (N = 29,926) surveys to estimate prevalence of compliance (95% confidence interval). Logistic model based standardization methods were applied to estimate standardized prevalence differences (SPrD) to the overall distribution of age, sex, education, history of COVID-19, and residence of other >60 yrs in the household.

Results

We observed that adults living with children more frequently avoided bars (SPrDENE-COVID: 4.2%; 95% CI: 2.3-6.1), crowded places (SPrDCOSMO: 8.0%; 95% CI: 0.6-15.1) and did not use public transportation (SPrDENE-COVID: 4.9%; 95% CI: 3.0-6.7). They were also more worried about work and family conciliation (SPrDCOSMO: 12.2%; 95% CI: 4.8-19.5) and about closure of education centers (SPrDCOSMO: 26.5%; 95% CI: 19.4-33.6).

Discussion

In general, adults living with children adopted slightly more frequently social distancing measures.

Assessing Differences in Attitudes toward Occupational Safety and Health Measures for Infection Control between Office and Assembly Line Employees during the COVID-19 Pandemic in Germany: A Cross-Sectional Analysis of Baseline Data from a Repeated Employee Survey

In our study, we investigated possible differences across occupational groups regarding employees’ perceived work-related risk of infection with SARS-CoV-2, attitudes toward technical, organisational, and personal occupational safety and health (OSH) measures for infection control, and factors associated with this attitude. We analysed baseline data (10 August to 25 October 2020) from a repeated standardised online survey distributed at a worldwide leading global supplier of technology and services in Germany. 2144 employees (32.4% women; age (mean ± SD): 44 ± 11 years) who worked predominantly remotely (n = 358), at an on-site office (n = 1451), and assembly line/manufacturing (n = 335) were included. The work-related SARS-CoV-2 risk of infection differed between office employees working remotely and on-site (mean ± SD = 2.9 ± 1.5 vs. 3.2 ± 1.5; Mann-Whitney-U-Test: W = 283,346; p < 0.002; ε2 = 0.01) and between on-site office and assembly line/manufacturing employees (3.8 ± 1.7; W = 289,174; p < 0.001; ε2 = 0.02). Attitude scores toward technical OSH-measures differed between remote and on-site office (4.3 ± 0.5 vs. 4.1 ± 0.6; W = 216,787; p < 0.001; ε2 = 0.01), and between on-site office and assembly line/manufacturing employees (3.6 ± 0.9; W = 149,881; p < 0.001; ε2 = 0.07). Findings were similar for organisational and personal measures. Affective risk perception, COVID-19-specific resilience, and information about COVID-19-related risks were associated with the employees’ attitudes. To promote positive attitudes, it seems to be important to consider occupational-group-specific context factors when implementing OSH-measures for infection control.

Behavioral and Cultural Insights, a Nationwide Study Based on Repetitive Surveys of WHO Behavioral Insights Tool in Greece Regarding COVID-19 Pandemic and Vaccine Acceptance

Monitoring behavioral and cultural insights during the pandemic is a useful tool to identify factors related to COVID-19 vaccine acceptance and confront the pandemic’s vast impact. Data were collected using a questionnaire designed according to the “survey tool and guidance” provided by the World Health Organization (WHO). Surveys were conducted by a market research company for five consecutive months, with a sample of 1000 individuals recruited per survey. Vaccination acceptance increased from 55.2% to 67.2%, while the percentage of undecisive individuals decreased from 16.3% to 10.6%. The proportion of vaccine resistant participants remained relatively steady (25−30%). Knowledge about the pandemic and compliance with preventive measures was high (>90%). Factors associated with vaccination included: Increased age, male gender, influenza vaccination, following authorities’ recommendations, being informed by HCWs or formal information sources, care for others, concern about the country’s economic recession and health system overload. Pandemic fatigue was reflected across the surveys, indicated by a decrease in the intention to self-isolate and remain at home when ill. Despite the decrease of undecisive individuals, a firm core of vaccine resistant individuals may be responsible for the relatively lower vaccine coverage compared to northern EU countries. Study results could be useful for developing approaches tailored to a reluctant population.

Validation of the Spanish Version of the Fear of COVID-19 Scale (FCV-19S) in Long-Term Care Settings

Fear of coronavirus disease 2019 (COVID-19) is one of the main psychological impacts of the actual pandemic, especially among the population groups with higher mortality rates. The Fear of COVID-19 Scale (FCV-19S) has been used in different scenarios to assess fear associated with COVID-19, but this has not been done frequently in people living in long-term care (LTC) settings. The present study is aimed at measuring the psychometric properties of the Spanish version of the FCV-19S in residents in LTC settings, following both the classical test theory (CTT) and Rasch model frameworks. The participants (n = 447), aged 60 years or older, were asked to complete the FCV-19S and to report, among other issues, their levels of depression, resilience, emotional wellbeing and health-related quality of life with validated scales. The mean FCV-19S score was 18.36 (SD 8.28, range 7−35), with higher scores for women, participants with lower education (primary or less) and higher adherence to preventive measures (all, p < 0.05). The Cronbach’s alpha for the FCV-19S was 0.94. After eliminating two items due to a lack of fit, the FCV-19S showed a good fit to the Rasch model (χ2 (20) = 30.24, p = 0.019, PSI = 0.87), with unidimensionality (binomial 95% CI 0.001 to 0.045) and item local independency. Question 5 showed differential item functioning by sex. The present study shows that the FCV-19S has satisfactory reliability and validity, which supports its use to effectively measure fear in older people living in LTC settings. This tool could help identify risk groups that may need specific health education and effective communication strategies to lower fear levels. This might have a beneficial impact on adherence to preventive measures.

Age differences in knowledge, attitudes and preventive practices during the COVID-19 pandemic in Spain

This study aims at describing the evolution of Spanish population preventive practices during the COVID-19 pandemic of the between January and June 2021, and differences by age group. Data was drawn from the COSMO-Spain online survey, rounds (R) 4, 5 and 6. Multiple linear regression models with preventive practices as dependent variable were performed. Preventive practices (p = 0.001) and concern about coronavirus (p = 0.003) decreased throughout the three rounds, knowledge decreased from R4 to R6 (p = 0.002) and health literacy had a higher value in R6 (p < 0.001). Older the age was associated with higher the frequency of preventive practices, and levels of health literacy and concern about coronavirus (p < 0.001). The regression model showed that, in the 18-29 year group, a greater frequency of preventive practices was associated with being female (β = 0.20; p < 0.001), greater concern about coronavirus (β = 0.16; p < 0.018) and frequency of information seeking (β = 0.24; p < 0.001). For 61 years old and older, a higher frequency of preventive practices was associated with greater concern about coronavirus (β = 0.21; p < 0.002) and lower pandemic fatigue (β = - 0.13; p < 0.037). These findings point to the need for effective public health interventions tailored to the characteristics of age population groups.

Compliance with COVID-19 Prevention Measures in the Spanish Population during the New Normal: Will the Need for Greater Community Involvement Be One of the Lessons Learned?

Throughout the pandemic, national and international health authorities have called on the population to collaborate and contribute with their behavior to control the problem. The aim of this study is to analyze the implementation of the protective measures against COVID-19 and to determine the factors involved in their compliance. To respond to the objectives, a cross-sectional study was performed involving a total of 5560 individuals. An ad hoc online questionnaire was created and shared through social networks, scientific societies, and various health institutions. The probability of high or total compliance with the protective measures was higher in women (OR = 1.401) and as age increases, with an OR = 2.524 in the interval between 31 and 64 years old and an OR = 2.896 in the oldest interval (65 and over). This study shows the characteristics of the population that considers it more likely to be infected by SARS-CoV-2, thus adopting greater adherence to prevention measures. Knowing which factors are associated with adherence to protective measures is essential for establishing effective pandemic control measures. Our findings may be useful for designing future awareness campaigns adapted to different socio-demographic characteristics in settings affected by COVID-19.

Trends in COVID-19 Vaccine Acceptance in Spain, September 2020‒May 2021

Objectives. To analyze factors associated with COVID-19 vaccine acceptance in Spain, over time. Methods. We used data from a national study that included 5 online surveys carried out every 2 months from September 2020 to May 2021. Each round recruited a sample of 1000 participants aged 18 years or older. We performed a multivariable logistic regression with vaccination acceptance as the dependent variable. We evaluated time trends through the interaction terms of each of the explanatory variables and the time. Results. Vaccination acceptance increased from 43.1% in September 2020 to 84.5% in May 2021. Sex, age, concerns about disease severity, health services overload, and people not wearing a face mask, together with adherence to preventive behavior, health literacy, and confidence in scientists, health care professionals' information, and adequacy of governmental decisions, were variables associated with vaccination acceptance. Conclusions. In a changing situation, vaccine acceptance factors and time trends could help in the design of contextualized public health messages. It is important to strengthen the population's trust in institutions, health care professionals, and scientists to increase vaccination rates, as well as to ensure easy access to accurate information for those who are more reluctant. (Am J Public Health. 2022;112(11):1611-1619. https://doi.org/10.2105/AJPH.2022.307039).

Breastfeeding Women's Attitudes About the SARS-COV-2 Vaccine in Spain

BACKGROUND

Severe Acute Respiratory Syndrome Coronavirus 2 has spread globally, causing the coronavirus disease 2019 (COVID-19) pandemic. To control the pandemic and to achieve herd immunity, four vaccines have obtained market authorization in Europe. Researchers have reported that the sequence of administration of the vaccines depends on the risk of exposure to COVID-19 and age, recommending the vaccine to pregnant and breastfeeding women.

RESEARCH AIM

To examine the knowledge, willingness and attitudes of breastfeeding women in Spain regarding the possibility of receiving the COVID-19 vaccine.

METHODS

An observational descriptive cross-sectional study in two tertiary-level hospitals from Valencia was conducted. Breastfeeding women (N = 301) were recruited by non-probability sampling of consecutive cases. Questionnaires were collected in June 2021.

RESULTS

More than one in every two participants would accept a COVID-19 vaccine, and the percentage rose in participants who were older, more educated, or worked in high-risk jobs. Their main source of information was the Internet, and midwives were the professionals who most recommended vaccination. Participants who would not accept vaccination during lactation reported reasons linked to lack of information regarding vaccination in their condition and how it might affect newborns.

CONCLUSION

It is of primary concern for healthcare professionals to foster a greater understanding by providing updated information regarding the need, safety, and efficacy of the vaccine for both lactating mothers and their newborns.

Predictors for adherent behavior in the COVID-19 pandemic: A cross-sectional telephone survey

Background

During the COVID-19 pandemic, protective measures have been prescribed to prevent or slow down the spread of the SARS-CoV-2 virus and protect the population. Individuals follow these measures to varying degrees. We aimed to identify factors influencing the extent to which protective measures are adhered to.

Methods

A cross-sectional survey (telephone interviews) was undertaken between April and June 2021 to identify factors influencing the degree to which individuals adhere to protective measures. A representative sample of 1,003 people (age >16 years) in two Austrian states (Carinthia, Vorarlberg) was interviewed. The questionnaire was based on the Health Belief Model, but also included potential response-modifying factors. Predictors for adherent behavior were identified using multiple regression analysis. All predictors were standardized so that regression coefficients (β) could be compared.

Results

Overall median adherence was 0.75 (IQR: 0.5-1.0). Based on a regression model, the following variables were identified as significant in raising adherence: higher age (β = 0.43, 95%CI: 0.33-0.54), social standards of acceptable behavior (β = 0.33, 95%CI: 0.27-0.40), subjective/individual assessment of an increased personal health risk (β = 0.12, 95%CI: 0.05-0.18), self-efficacy (β = 0.06, 95%CI: 0.02-0.10), female gender (β = 0.05, 95%CI: 0.01-0.08), and low corona fatigue (behavioral fatigue: β = -0.11, 95%CI: -0.18 to -0.03). The model showed that such aspects as personal trust in institutions, perceived difficulties in adopting health-promoting measures, and individual assessments of the risk of infection, had no significant influence.

Conclusions

This study reveals that several factors significantly influence adherence to measures aimed at controlling the COVID-19 pandemic. To enhance adherence, the government, media, and other relevant stakeholders should take the findings into consideration when formulating policy. By developing social standards and promoting self-efficacy, individuals can influence the behavior of others and contribute toward coping with the pandemic.

Psychometric Properties of the COVID-19 Pandemic Fatigue Scale: Cross-sectional Online Survey Study

Background

Pandemic fatigue is defined as feelings of demotivation to follow preventive measures against COVID-19, together with decreased trust in government and frequency of information-seeking behaviors.

Objective

This study aims to analyze the psychometric properties of the COVID-19–specific pandemic fatigue scale according to classical test theory (CTT) and Rasch model approaches in the general Spanish population.

Methods

This was a cross-sectional study in a representative sample of 1018 adults who completed an online survey in November 2020 in the framework of the COVID-19 Snapshot Monitoring (COSMO)-Spain project. The assessments included the 6-item COVID-19 Pandemic Fatigue Scale (CPFS) and other COVID-19–related variables: COVID-19 infection, adherence to preventive behaviors, information-seeking behavior, self-efficacy, worry, and cognitive and affective risk perception. Data quality, acceptability, reliability, and validity were analyzed according to CTT, and the fit to the Rasch model, unidimensionality, appropriateness of the response scale, item local independency, reliability (person-separation index [PSI]), and item-person distribution were also calculated.

Results

The mean CPFS score was 17.06 (SD 5.04, range 6-30), with higher scores for women, younger participants, participants who never seek information on COVID-19, those who think they would contract a mild disease in case of infection, those with higher level of worry about coronavirus/COVID-19, and those who felt depressed or felt the coronavirus/COVID-19 is spreading slowly (all P<.01). The Cronbach alpha for the CPFS was 0.74. In the confirmatory factor analysis, one factor was identified (root mean square error of approximation [RMSEA]=.02; comparative fit index [CFI]=.99; χ²₅=8.06, P=.15). The CPFS showed good fit to the Rasch model (χ ²₂₄=42.025, P=.01, PSI=.642), unidimensionality (binomial 95% CI –.005 to .045), and item local independency.

Conclusions

Our results suggest that the CPFS has moderate reliability and internal consistency and it is composed of a single dimension. It is a useful tool to ascertain the level of pandemic fatigue in the general population, which may help to guide the communication and information strategies to face the COVID-19 pandemic.

Factors Associated with the COVID-19 Vaccination Status of Higher Education Students: Results of an Online Cross-Sectional Survey at Six Universities in Southwestern Germany

This cross-sectional study explored factors associated with the corona virus disease 2019 (COVID-19) vaccination acceptance among higher education students in southwestern Germany. We conducted a cross-sectional online survey at six state-approved higher education institutions (HEIs) between July and November 2021. In addition to descriptive analyses, univariate as well as multivariate binary logistic regression analyses were conducted. A total of 6556 higher education students aged 18 years and older participated in our survey; 91.4% of participating students had been vaccinated against COVID-19 at least once. The factors that significantly contributed to the explanation of higher education students’ vaccination status in the multivariate analysis (area under curve—AUC = 0.94) were variables on the perception of the virus SARS-CoV-2 (affective risk perception: Adjusted odds ratio—aOR = 1.2; perception of the outbreak as a media-hype: aOR = 0.8), attitudes towards personal (aOR = 0.7) and study-related (aOR = 0.8) health and safety measures to prevent transmission of SARS-CoV-2, and attitudes towards COVID-19 vaccination (preservation of own health: aOR = 1.3; confidence in vaccine safety: aOR = 1.7; supporting higher education through vaccination: aOR = 1.2; own contribution to the containment of the pandemic: aOR = 1.7). The findings target assisting HEIs in returning to face-to-face teaching after previous semesters of online teaching.

[Biomedical research and innovation and COVID-19 syndemic. SESPAS Report 2022]

Objetivo

Describir críticamente la respuesta en investigación e innovación (I + I) contra la sindemia por COVID-19 en el ámbito nacional, contextualizada internacionalmente.

Método

Revisión narrativa dirigida.

Resultados

En la sindemia por COVID-19 se ha pasado la presión a la comunidad científica en general, e innovadora biomédica en particular, para aportar soluciones sobre todo de productos biotecnológicos. La mayoría de las recomendaciones de paneles expertos no van orientadas a una respuesta biotecnológica (que también debe existir), sino de gobernanza, organizativa, socioeconómica y de apoyo a las infraestructuras de salud pública. Existe un déficit importante en la inclusión de la perspectiva de género en la I + I por COVID-19. La sindemia ha ofrecido una oportunidad (desaprovechada) para potenciar la I + I desde la perspectiva epidemiológica contra brotes infecciosos con potencial de provocar crisis en salud pública reivindicando el liderazgo desde la epidemiología. Hace falta evaluar si la gran inversión en I + I biomédica orientada a la medicina personalizada puede integrarse eficientemente en los proveedores públicos de salud ante crisis sanitarias.

Conclusiones

Es urgente diseñar una estrategia de I + I en España en línea con los fondos disponibles internacionalmente y que se beneficie de ellos, pero que provea al país del máximo de independencia de cara a afrontar situaciones críticas para la salud pública.

Perimeter confinements of basic health zones and COVID-19 incidence in Madrid, Spain

Background

A unique policy of perimeter closures of Basic Health Zones (small administrative health units) was implemented in the Autonomous Community of Madrid from September 21st 2020 to May 23rd 2021 to face the COVID-19 pandemic.

Aim

To assess the impact of local perimeter confinements on the 14-days cumulative incidence of SARS-CoV-2 during the second wave of the pandemic in Madrid, Spain.

Methods

We compare the errors in estimation of two families of mathematical models: ones that include the perimeter closures as explanatory covariables and ones that do not, in search of a significant improvement in estimation of one family over the other. We incorporate leave-one-out cross-validation, and at each step of this process we select the best model in AIC score from a family of 15 differently tuned ones.

Results

The two families of models provided very similar estimations, for a 1- to 3-weeks delay in observed cumulative incidence, and also when restricting the analysis to only those Basic Health Zones that were subject to at least one closure during the time under study. In all cases the correlation between the errors yielded by both families of models was higher than 0.98 (±10^− 3 95% CI), and the average difference of estimated 14-days cumulative incidence was smaller than 1.49 (±0.33 95% CI).

Conclusion

Our analysis suggests that the perimeter closures by Basic Health Zone did not have a significant effect on the epidemic curve in Madrid.

Compliance with the main preventive measures of COVID-19 in Spain: The role of knowledge, attitudes, practices, and risk perception

In epidemics such as COVID‐19, major changes need to be made to the population's behavior to prevent infection and stop disease transmission. The three most recommended preventive measures are wearing a mask, washing hands with soap or hydroalcoholic gel, and watching an interpersonal distance of at least two meters (3W) from other people. This study aimed to assess adherence to these COVID‐19‐related three preventive measures and its association with knowledge, attitudes, risk perception, and practices in Spain. The COSMO‐Spain survey, based on the WHO Behavioral Insights questionnaire on COVID‐19, was conducted in the general Spanish population using an online questionnaire (n = 1,033). Sociodemographic, knowledge, attitudes, practices, and risk perception variables were included. A multivariable logistic regression model was carried out to evaluate the factors associated with compliance with the three preventive measures. Half of the respondents (49.8%) were women with a median age of 45 (Inter‐quartile Range, IR = 21) years. In the logistic regression, the factors associated with 3W compliance were being over 45 years; knowing about how COVID‐19 spreads and wearing masks properly; appropriate attitudes towards COVID‐19 (greater agreement with mandatory mask use); high risk perception (feeling that the coronavirus is spreading rapidly, being concerned about non‐mask wearers), and adherence to other preventive measures against COVID‐19, such as staying at home. Adequate knowledge, attitudes and risk perception are determinants of 3W compliance. Developing effective health education programs and frequent communication strategies are necessary, particularly for those who adhere less to preventive measures.