Determinants of protective behaviours during a nationwide lockdown in the wake of the COVID-19 pandemic

Social Vulnerability and Compliance With World Health Organization Advice on Protective Behaviors Against COVID-19 in African and Asia Pacific Countries: Factor Analysis to Develop a Social Vulnerability Index

BACKGROUND

COVID-19 protective behaviors are key interventions advised by the World Health Organization (WHO) to prevent COVID-19 transmission. However, achieving compliance with this advice is often challenging, particularly among socially vulnerable groups.

OBJECTIVE

We developed a social vulnerability index (SVI) to predict individuals' propensity to adhere to the WHO advice on protective behaviors against COVID-19 and identify changes in social vulnerability as Omicron evolved in African countries between January 2022 and August 2022 and Asia Pacific countries between August 2021 and June 2022.

METHODS

In African countries, baseline data were collected from 14 countries (n=15,375) during the first Omicron wave, and follow-up data were collected from 7 countries (n=7179) after the wave. In Asia Pacific countries, baseline data were collected from 14 countries (n=12,866) before the first Omicron wave, and follow-up data were collected from 9 countries (n=8737) after the wave. Countries' socioeconomic and health profiles were retrieved from relevant databases. To construct the SVI for each of the 4 data sets, variables associated with COVID-19 protective behaviors were included in a factor analysis using polychoric correlation with varimax rotation. Influential factors were adjusted for cardinality, summed, and min-max normalized from 0 to 1 (most to least vulnerable). Scores for compliance with the WHO advice were calculated using individuals' self-reported protective behaviors against COVID-19. Multiple linear regression analyses were used to assess the associations between the SVI and scores for compliance to WHO advice to validate the index.

RESULTS

In Africa, factors contributing to social vulnerability included literacy and media use, trust in health care workers and government, and country income and infrastructure. In Asia Pacific, social vulnerability was determined by literacy, country income and infrastructure, and population density. The index was associated with compliance with the WHO advice in both time points in African countries but only during the follow-up period in Asia Pacific countries. At baseline, the index values in African countries ranged from 0.00 to 0.31 in 13 countries, with 1 country having an index value of 1.00. The index values in Asia Pacific countries ranged from 0.00 to 0.23 in 12 countries, with 2 countries having index values of 0.79 and 1.00. During the follow-up phase, the index values decreased in 6 of 7 African countries and the 2 most vulnerable Asia Pacific countries. The index values of the least vulnerable countries remained unchanged in both regions.

CONCLUSIONS

In both regions, significant inequalities in social vulnerability to compliance with WHO advice were observed at baseline, and the gaps became larger after the first Omicron wave. Understanding the dimensions that influence social vulnerability to protective behaviors against COVID-19 may underpin targeted interventions to enhance compliance with WHO recommendations and mitigate the impact of future pandemics among vulnerable groups.

"Oh no, they caught it!": Vicarious experience of COVID-19, protection motivation and protective behaviors

Utilizing the components of the protection motivation theory, this study investigated the role of close others' diagnosis of COVID-19 (as a vicarious experience) in individuals' adherence to protective behavior against COVID-19. Path analysis of online survey data from 3695 participants showed that the presence of a diagnosed close other was positively related to perceived vulnerability, while being negatively related to perceived response efficacy and self-efficacy. In addition, perceived severity and efficacy appraisals were positively associated with protective behavioral tendencies. Although efficacy appraisal mediated the relationship between vicarious experience and protective behavior, threat appraisal did not mediate this relationship. In sum, the results suggest that efficacy appraisal derived from vicarious experiences can be more consequential for protective behaviors than threat appraisal. Implications of these results on future large-scale health crises are discussed along with limitations and future directions.

Predicting the use of a COVID-19 contact tracing application: A study across two points of measurements

Contact tracing mobile applications (apps) were important in combating the COVID-19 pandemic. Most previous studies predicting contact tracing app use were cross-sectional and not theory-based. This study aimed at contributing to a better understanding of app use intentions and app use by applying an extended version of the protection motivation theory across two measurement points while accounting for the development of the pandemic. A total of N = 1525 participants from Switzerland (Mage = 53.70, SD = 18.73; 47% female; n = 270 completed both assessments) reported on risk perceptions, response efficacy, self-efficacy, social norms, trust in government, trust in the healthcare system, active search of COVID-19-related information, intentions for and actual (self-reported) app use. Analyses included country-specific incidences and death toll. Increases in response-efficacy, self-efficacy, trust in government, and the active search of COVID-19-related information predicted increased app-use intentions. Increases in self-efficacy, intentions, and the active search of COVID-19-related information predicted increased self-reported app use. Risk perceptions, incidence, and death toll were unrelated to both outcomes. Across an aggravation of the pandemic situation, intentions for and app use were primarily related to response-efficacy, self-efficacy, trust in government, and the active search of COVID-19-related information.

Are Fear Campaigns Effective for Increasing Adherence to COVID-Related Mitigation Measures?

BACKGROUND

Using fear to increase the uptake of preventative health behaviours is a longstanding practice, which could be useful in mitigating the spread of COVID-19. However, the impact of fear campaigns beyond behavioural outcomes has rarely been considered. It is possible that these threatening health messages could heighten health-related anxiety by inducing a tendency to interpret ambiguous stimuli in a threatening manner. This research aimed to evaluate the effects of fear-based articles about COVID-19, on intentions to adhere to mitigation measures and interpretation bias-a core maintenance factor in health anxiety.

METHOD

Two pilot studies were conducted with the aim of validating our novel COVID-related measures and assessing engagement with the threat manipulation. Following this, 375 community members were recruited through social media for the main study. Participants were then randomly allocated to read an article about COVID which was manipulated on both threat and efficacy. After reading the article, participants then completed measures of interpretation bias and intentions to engage in COVID-19 mitigation measures.

RESULTS

Although the threatening articles consistently produced greater COVID-related threat, they only generated a stronger interpretation bias in the first pilot study. Importantly, threat-based communications failed to enhance intentions to perform mitigation measures in any of the studies. Likewise, reading an article which bolstered self-efficacy did not increase intentions, compared to reading a low efficacy article.

CONCLUSION

This research suggests that fear appeals are unlikely to increase intentions to perform COVID-related mitigation measures.

Interplay of Digital Proximity App Use and SARS-CoV-2 Vaccine Uptake in Switzerland: Analysis of Two Population-Based Cohort Studies

Objectives: Our study aims to evaluate developments in vaccine uptake and digital proximity tracing app use in a localized context of the SARS-CoV-2 pandemic. Methods: We report findings from two population-based longitudinal cohorts in Switzerland from January to December 2021. Failure time analyses and Cox proportional hazards regression models were conducted to assess vaccine uptake and digital proximity tracing app (SwissCovid) uninstalling outcomes. Results: We observed a dichotomy of individuals who did not use the SwissCovid app and did not get vaccinated, and who used the SwissCovid app and got vaccinated during the study period. Increased vaccine uptake was observed with SwissCovid app use (aHR, 1.51; 95% CI: 1.40-1.62 [CI-DFU]; aHR, 1.79; 95% CI: 1.62-1.99 [CSM]) compared to SwissCovid app non-use. Decreased SwissCovid uninstallation risk was observed for participants who got vaccinated (aHR, 0.55; 95% CI: 0.38-0.81 [CI-DFU]; aHR, 0.45; 95% CI: 0.27-0.78 [CSM]) compared to participants who did not get vaccinated. Conclusion: In evolving epidemic contexts, these findings underscore the need for communication strategies as well as flexible digital proximity tracing app adjustments that accommodate different preventive measures and their anticipated interactions.

Health and Environmental Protective Behavioral Intentions for Reducing Harm from Water Pollutants

Understanding what motivates people to adopt protective behaviors is important in developing effective risk messaging. Motivations may vary depending on the nature of the risk and whether it poses a personal or impersonal threat. Water pollution creates both personal (human health) and impersonal (environmental) threats, yet few studies have examined people's motivations to protect both personal health and environmental health. Protection motivation theory (PMT) uses four key variables to predict what motivates individuals to protect themselves in relation to a perceived threat. Using data from an online survey (n = 621), we investigated the relationships between PMT variables related to health and environmental protective behavioral intentions related to toxic water pollutants among residents in Oregon, Idaho, and Washington, USA. Among PMT variables, high self-efficacy (belief in one's own capacity to carry out certain behaviors) significantly predicted both health and environmental protective behavioral intentions for water pollutants, while perceived severity of the threat was only significant in the environmental behavioral intentions model. Perceived vulnerability and response efficacy (belief that a specific behavior will effectively mitigate the threat) were significant in both models. Education level, political affiliation, and subjective knowledge of pollutants were significant predictors of environmental protective behavioral intentions, but not health protective behavioral intentions. The results of this study suggest that when communicating environmental risks of water pollution, highlighting self-efficacy in messaging is particularly important to promote protective environmental and personal health behavior.

Observed and self-reported COVID-19 health protection behaviours on a university campus and the impact of a single simple intervention

During the COVID-19 pandemic, most data on adherence to health protective behaviours were collected via a self-report. We quantified the discrepancy between self-report data and discretely observed behaviour in a sample of university staff and students. We assessed the prevalence of cleaning hands, wearing a face-covering and maintaining distance from others. We also tested whether additional signage reminding people that these behaviours were mandatory improved observed adherence. Prevalence estimates based on self-report were higher than those based on observations. Signage was associated with improvements for observed behaviours (all χ2 ≥ 6.0, P < 0.05). We caution that self-reported data can produce misleading adherence rates.

Personal protective behaviors in response to COVID-19: a longitudinal application of protection motivation theory

Introduction

Disease outbreaks are expected to occur more frequently and spread more rapidly in the age of globalization. Personal protective behaviors strongly affect infection and death rates worldwide. It is therefore of prime importance to better understand which factors predict personal protective behaviors during a pandemic. Protection motivation theory (PMT) proposes that people's motivation to protect themselves is based on two appraisal processes: threat appraisal and coping appraisal. Building on PMT, this longitudinal study aimed to predict personal protective behaviors in response to COVID-19, including hand hygiene, physical distancing, and mask wearing.

Method

In the first wave of the study (November, 2020), the two appraisal processes as specified in PMT as well as intentions to perform protective behaviors were assessed in a representative sample of German adults (N = 328). In the second wave of this study, which was conducted one month later, the frequency of protective behaviors was measured. Structural equation modeling was used to test whether threat and coping appraisal predicted intentions and protective behaviors.

Results

Response rate for the second wave was high (87%). For all three behaviors, self-efficacy predicted intentions and also indirectly behavior (i.e., mediated via intentions). Furthermore, exploratory tests of alternative theoretical models suggested that both self-efficacy and costs have direct effects (i.e., independent from their relationship with intentions) on performed behavior.

Conclusion

To support individuals to engage in protective behaviors during a pandemic, it is important to reduce barriers to action and to foster individuals' self-efficacy.

Media exposure, threat processing, and mitigation behaviors in Gulf Coast residents facing the co-occurring threats of COVID-19 and hurricanes

The 2020 hurricane season threatened millions of Americans concurrently grappling with COVID-19. Processes guiding individual-level mitigation for these conceptually distinct threats, one novel and chronic (COVID-19), the other familiar and episodic (hurricanes), are unknown. Theories of health protective behaviors suggest that inputs from external stimuli (e.g., traditional and social media) lead to threat processing, including perceived efficacy (self- and response) and perceived threat (susceptibility and severity), guiding mitigation behavior. We surveyed a representative sample of Florida and Texas residents (N = 1846) between April 14, 2020 and April 27, 2020; many had previous hurricane exposure; all were previously assessed between September 8, 2017 and September 11, 2017. Using preregistered analyses, two generalized structural equation models tested direct and indirect effects of media exposure (traditional media, social media) on self-reported (1) COVID-19 mitigation (handwashing, mask-wearing, social distancing) and (2) hurricane mitigation (preparation behaviors), as mediated through perceived efficacy (self- and response) and perceived threat (susceptibility and severity). Self-efficacy and response efficacy were associated with social distancing (p = .002), handwashing, mask-wearing, and hurricane preparation (ps < 0.001). Perceived susceptibility was positively associated with social distancing (p = 0.017) and hurricane preparation (p < 0.001). Perceived severity was positively associated with social distancing (p < 0.001). Traditional media exhibited indirect effects on COVID-19 mitigation through increased response efficacy (ps < 0.05), and to a lesser extent self-efficacy (p < 0.05), and on hurricane preparation through increased self-efficacy and response efficacy and perceived susceptibility (ps < 0.05). Social media did not exhibit indirect effects on COVID-19 or hurricane mitigation. Communications targeting efficacy and susceptibility may encourage mitigation behavior; research should explore how social media campaigns can more effectively target threat processing, guiding protective actions.

Effects of Cognitive Appraisals on Perceived Self-Efficacy and Distress during the COVID-19 Lockdown: An Empirical Analysis Based on Structural Equation Modeling

During the COVID-19 lockdown, individuals and households had to responsibly manage the difficulties and problems caused by the restrictions on their mobility, such as the interruptions to work schedules, insecure food supplies, and the procurement of services and health care. The perceptions of risk as well as the fear of disease were strongly linked to worry, defined as a sequence of thoughts that evoke negative emotions and elevated levels of anxiety and distress. This study evaluated how different cognitive appraisals of an individual's sources of worry could influence their perceived self-efficacy and directly or indirectly moderate their perceived general distress. A sample of 544 participants completed a survey that included questions based on the generalized self-efficacy scale, the sources of concern during the epidemic, the cognitive appraisal scale in emergency, and perceived discomfort. Subsequently, a structural-equation-modeling (SEM) analysis was performed to test the moderating role of cognitive appraisals and perceived self-efficacy on participants' overall distress during a lockdown. Overall, the model reported acceptable fit values and confirmed the hypotheses of the study. An individual's worries activated either a dysfunctional threat appraisal, which prompted a fear-and-closure response that then increased their overall state of distress; or two other functional appraisals (i.e., adaptive or supportive) that contributed to significantly improving the individual's self-efficacy. Higher self-efficacy was shown to be associated with lower levels of perceived distress. For the purposes of prevention and distress containment, it would be appropriate to promote psycho-educational interventions that promote the adoption of appraisal strategies that are functional and beneficial for perceived self-efficacy.

Psychosocial Predictors and Mediators Relating to the Preventive Behaviors of Hospital Workers During the COVID-19 Pandemic in Turkey

OBJECTIVE

The aim is to analyze the relation of psychosocial factors to COVID-19 contraction, vaccination, and preventive health behavior in and outside work.

METHODS

The questionnaire data from hospital-workers in Turkey is analyzed using independent-samples t-test, logistic regression, linear regression, and mediation analyses. We developed a questionnaire on mask-hygiene-distance measures and also used previously developed scales including the Big Five Personality Questionnaire, Young Schema Questionnaire Short Form 3, Schwartz's Basic Human Values Scale, Short Dark Triad.

RESULTS

The odds of being infected by COVID-19 increases by self-direction. The odds of being vaccinated increases by age and conformity, and decreases by emotional stability. Education predicts certain preventive behaviors at work negatively and outside work positively. Older age, being a woman, having chronic disease, the self-transcendence and conservation values, agreeableness, and conscientiousness predict more preventive behaviors. The self-enhancement and openness to change values, the Dark Triad, and early maladaptive schemas predict more risky behaviors.

CONCLUSIONS

Designing prohealth policies requires further elaboration on the relation of psychosocial factors to preventive behaviors.

Testing a simple and frugal model of health protective behaviour in epidemic times

The COVID-19 epidemic highlighted the necessity to integrate dynamic human behaviour change into infectious disease transmission models. The adoption of health protective behaviour, such as handwashing or staying at home, depends on both epidemiological and personal variables. However, only a few models have been proposed in the recent literature to account for behavioural change in response to the health threat over time. This study aims to estimate the relevance of TELL ME, a simple and frugal agent-based model developed following the 2009 H1N1 outbreak to explain individual engagement in health protective behaviours in epidemic times and how communication can influence this. Basically, TELL ME includes a behavioural rule to simulate individual decisions to adopt health protective behaviours. To test this rule, we used behavioural data from a series of 12 cross-sectional surveys in France over a 6-month period (May to November 2020). Samples were representative of the French population (N = 24,003). We found the TELL ME behavioural rule to be associated with a moderate to high error rate in representing the adoption of behaviours, indicating that parameter values are not constant over time and that other key variables influence individual decisions. These results highlight the crucial need for longitudinal behavioural data to better calibrate epidemiological models accounting for public responses to infectious disease threats.

Handwashing adherence during the COVID-19 pandemic: A longitudinal study based on protection motivation theory

RATIONALE

The associations between the number of COVID-19 cases/deaths and subsequent uptake of protective behaviors may reflect cognitive and behavioral responses to threat-relevant information.

OBJECTIVE

Applying protection motivation theory (PMT), this study explored whether the number of total COVID-19 cases/deaths and general anxiety were associated with cross-situational handwashing adherence and whether these associations were mediated by PMT-specific self-regulatory cognitions (threat appraisal: perceived vulnerability, perceived illness severity; coping appraisal: self-efficacy, response efficacy, response costs).

METHOD

The study (#NCT04367337) was conducted in March-September 2020 among 1256 adults residing in 14 countries. Self-reports on baseline general anxiety levels, handwashing adherence across 12 situations, and PMT-related constructs were collected using an online survey at two points in time, four weeks apart. Values of COVID-19 cases and deaths were retrieved twice for each country (one week prior to the individual data collection).

RESULTS

Across countries and time, levels of adherence to handwashing guidelines were high. Path analysis indicated that smaller numbers of COVID-19 cases/deaths (Time 0; T0) were related to stronger self-efficacy (T1), which in turn was associated with higher handwashing adherence (T3). Lower general anxiety (T1) was related to better adherence (T3), with this effect mediated by higher response efficacy (T1, T3) and lower response cost (T3). However, higher general anxiety (T1) was related to better adherence via higher illness severity (T1, T3). General anxiety was unrelated to COVID-19 indicators.

CONCLUSIONS

We found a complex pattern of associations between the numbers of COVID-19 cases/deaths, general anxiety, PMT variables, and handwashing adherence at the early stages of the pandemic. Higher general anxiety may enable threat appraisal (perceived illness severity), but it may hinder coping appraisal (response efficacy and response costs). The indicators of the trajectory of the pandemic (i.e., the smaller number of COVID-19 cases) may be indirectly associated with higher handwashing adherence via stronger self-efficacy.

Group-based trajectories and predictors of adherence to physical distancing during the COVID-19 pandemic

Objective: This study sought to identify psychosocial predictors of trajectories of adherence to physical distancing alongside changes in public health measures during the COVID-19 pandemic. Design: A three-time point longitudinal survey during the first two waves of the COVID-19 pandemic. Methods: Participants (N = 1003) completed self-report measures of adherence to physical distancing over an 8-month period at the start (T1) and end (T2) of the first wave of the pandemic, and the start of the second wave of the pandemic (T3). Participants also completed measures of their health beliefs related to the self and others, social norms, emotional distress, and sociodemographic characteristics. Results: Using group-based trajectory modeling, four trajectories of adherence to physical distancing emerged: a high-adherence trajectory, a slow-declining trajectory, a fluctuating trajectory, and a fast-declining trajectory. The most important psychosocial predictors of poorer adherence trajectories included perceptions of lower self-efficacy and higher barriers to adherence, as well as lower prosocial attitudes towards physical distancing. Conclusion: Public health messages targeting these factors may be most relevant to promote sustained adherence to physical distancing over time in the context of a pandemic.

Predictors of protective behaviours during the Italian Covid-19 pandemic: an application of protection motivation theory

OBJECTIVE

The study investigated whether Protection Motivation Theory (PMT) constructs predicted recommended protective behaviours soon after the Italian lockdown and 1-year later.

DESIGN

A three-wave longitudinal design was used. Three-hundred-fifty-two adults completed online questionnaires with PMT and intention measures assessed during the Italian lockdown (T1), and behaviour measures assessed after 1-month (T2) and 1-year (T3).

OUTCOME MEASURES

Intentions to adopt behaviours (T1) and behaviour adherence at T2 and T3.

RESULTS

From T2 to T3, participants reported less adoption of distance behaviours, but higher face masks use. In SEM models, self-efficacy and perceived severity were the strongest predictors of intentions to engage in protective behaviours. Intentions (β = 0.490, p < 0.001) and fear arousal (β = 0.134 p = 0.035) predicted protective behaviours at T2. Intentions (β = 0.302, p = 0.001) and perceived severity (β = 0.431, p < 0.001) predicted protective behaviours at T3.

CONCLUSION

To increase intentions, intervention should highlight the severity of getting infected and target perceptions of one's ability to perform the protective behaviours. In addition, interventions should consider that at the beginning of the pandemic, fear predicted the adoption of preventive behaviours while perceived severity of the disease had a greater impact over time.

Perceived threat of COVID-19, attitudes towards vaccination, and vaccine hesitancy: A prospective longitudinal study in the UK

OBJECTIVES

Using the Health Belief Model as a conceptual framework, we investigated the association between attitudes towards COVID-19, COVID-19 vaccinations, and vaccine hesitancy and change in these variables over a 9-month period in a UK cohort.

METHODS

The COPE study cohort (n = 11,113) was recruited via an online survey at enrolment in March/April 2020. The study was advertised via the HealthWise Wales research registry and social media. Follow-up data were available for 6942 people at 3 months (June/July 2020) and 5037 at 12 months (March/April 2021) post-enrolment. Measures included demographics, perceived threat of COVID-19, perceived control, intention to accept or decline a COVID-19 vaccination, and attitudes towards vaccination. Logistic regression models were fitted cross-sectionally at 3 and 12 months to assess the association between motivational factors and vaccine hesitancy. Longitudinal changes in motivational variables for vaccine-hesitant and non-hesitant groups were examined using mixed-effect analysis of variance models.

RESULTS

Fear of COVID-19, perceived susceptibility to COVID-19, and perceived personal control over COVID-19 infection transmission decreased between the 3- and 12-month surveys. Vaccine hesitancy at 12 months was independently associated with low fear of the disease and more negative attitudes towards COVID-19 vaccination. Specific barriers to COVID-19 vaccine uptake included concerns about safety and efficacy in light of its rapid development, mistrust of government and pharmaceutical companies, dislike of coercive policies, and perceived lack of relaxation in COVID-19-related restrictions as the vaccination programme progressed.

CONCLUSIONS

Decreasing fear of COVID-19, perceived susceptibility to the disease, and perceptions of personal control over reducing infection-transmission may impact future COVID-19 vaccination uptake.

Italians locked down: people's responses to early COVID-19 pandemic public health measures

At the beginning of 2020, the widespread diffusion of SARS-CoV-2 rapidly became a worldwide priority. In Italy, the government implemented a lockdown for more than two months (March 9-May 18). Aware of the uniqueness of such an experience, we designed an online qualitative study focused on three main dimensions: daily life during the lockdown, relationships with others, and public health issues. The aim was to gain insights into people's experiences of, and attitudes toward, the changes caused by public health measures implemented as a response to the COVID-19 pandemic. We conducted 18 semi-structured interviews with Italian residents. The interviewees were recruited through mediators using purposive sampling to obtain a balanced sample with respect to age, gender, education, and geographical residence. Interviews were analyzed through qualitative content analysis. The lockdown affected a variety of aspects of people's life, resulting in a significant re-shaping of daily activities and relationships. These changes, which entailed both positive and negative aspects, were met with resilience. Even though public health measures were generally considered acceptable and adequate, they were also perceived to generate uncertainty and stress as well as to reveal tensions within the public health system. When tasked with imagining a scenario with saturated intensive care units and the need for selection criteria, respondents showed a tendency to dodge the question and struggled to formulate criteria. Media and news were found to be confusing, leading to a renewed critical attitude toward information. The findings shed some light on the impact of the lockdown on people's daily life and its effects on relationships with others. Furthermore, the study contributes to an understanding of people's reasons for, and capacity to respond to, emergency public health measures.

Typology and Characteristics of COVID-19 Preventive Measures Implementation

More than a year and a half has passed since the novel coronavirus (COVID-19) pandemic began, but according to the World Health Organization (WHO), the end is still a long way off. People must incorporate infection prevention behaviors into their daily lives, and the question for the future will not be whether or not to take countermeasures but how thoroughly to do so. In this study, I conducted an online survey of 1200 Japanese adults and identified four patterns of implementation of preventive measures. Those who took the most preventive measures were highly alert to the risk of COVID-19 and had strong anxiety about infection. They also positively evaluated risk management by medical institutions and the government, and they had positive feelings in their daily lives. On the other hand, those who took minimal measures, mainly mask wearing and handwashing, and those who took less than minimal measures did not feel much risk or anxiety about COVID-19. However, they evaluated the responses of the government and medical institutions less highly and reported having more negative feelings in their daily lives.

The Impact of Positivity and Parochial Altruism on Protective Behaviours during the First COVID-19 Lockdown in Italy

Implementation of COVID-19 protective behaviours, such as social distancing or frequent hand washing during the lockdown, was critical to prevent the spread of the COVID-19 pandemic. In this cross-sectional study, we examined the effect of positivity and parochial altruism on implementing COVID-19 health-protective behaviours during the Italian lockdown. A sample of 460 participants completed an online questionnaire that included demographic measures, Positivity Scale and COVID-19 measures of health-protective behaviours. To measure parochial altruism, we used a hypothetical dictator game played with others who could vary in their social distance from the participants. Results showed that participants in the hypothetical game gave more money to parents and siblings than to best friends, cousins, neighbours, and strangers. Furthermore, both positivity and parochial altruism (more altruism toward close vs. distant people) were positively associated with implementing hygiene behaviours but not with social distancing. Finally, mediation analysis showed that increases in parochial altruism mediated the effect of positivity on hygiene behaviour. These findings extend knowledge about the factors beyond the implementation of COVID-19 health-protective behaviours during a lockdown situation.

A systematic review of observational methods used to quantify personal protective behaviours among members of the public during the COVID-19 pandemic, and the concordance between observational and self-report measures in infectious disease health protection

OBJECTIVES

To assess the quantity and quality of studies using an observational measure of behaviour during the COVID-19 pandemic, and to narratively describe the association between self-report and observational data for behaviours relevant to controlling an infectious disease outbreak.

DESIGN

Systematic review and narrative synthesis of observational studies.

DATA SOURCES

We searched Medline, Embase, PsychInfo, Publons, Scopus and the UK Health Security Agency behavioural science LitRep database from inception to 17th September 2021 for relevant studies.

STUDY SELECTION

We included studies which collected observational data of at least one of three health protective behaviours (hand hygiene, face covering use and maintaining physical distance from others ('social distancing') during the COVID-19 pandemic. Studies where observational data were compared to self-report data in relation to any infectious disease were also included.

DATA EXTRACTION AND SYNTHESIS

We evaluated the quality of studies using the NIH quality assessment scale for observational studies, extracted data on sample size, setting and adherence to health protective behaviours, and synthesized results narratively.

RESULTS

Of 27,279 published papers on COVID-19 relevant health protective behaviours that included one or more terms relating to hand hygiene, face covering and social distancing, we identified 48 studies that included an objective observational measure. Of these, 35 assessed face covering use, 17 assessed hand hygiene behaviour and seven assessed physical distancing. The general quality of these studies was good. When expanding the search to all infectious diseases, we included 21 studies that compared observational versus self-report data. These almost exclusively studied hand hygiene. The difference in outcomes was striking, with self-report over-estimating observed adherence by up to a factor of five in some settings. In only four papers did self-report match observational data in any domains.

CONCLUSIONS

Despite their importance in controlling the pandemic, we found remarkably few studies assessing protective behaviours by observation, rather than self-report, though these studies tended to be of reasonably good quality. Observed adherence tends to be substantially lower than estimates obtained via self-report. Accurate assessment of levels of personal protective behaviour, and evaluation of interventions to increase this, would benefit from the use of observational methods.

Determinants of adoption and rejection of protective measures during the SARS-CoV-2 pandemic: A longitudinal study in Germany’s second wave