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Metzger C, Yaï J, Nassany O, Randriamampianina S, Vernay M. Factors associated with compliance with barrier gestures and social distancing measures in France. JOURNAL OF EPIDEMIOLOGY AND POPULATION HEALTH 2024; 72:202194. [PMID: 38523401 DOI: 10.1016/j.jeph.2024.202194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 03/26/2024]
Abstract
BACKGROUND The COVID-19 pandemic led many countries to drastically limit social activities. The objective of this study is to describe the factors associated with compliance with protective measures and social distancing in the general adult population in France, between March and December 2020 (first and second waves of the epidemic), before vaccination began at the end of December 2020. METHOD The data come from the CoviPrev repeated cross-sectional descriptive survey, conducted between March 2020 and December 2022 in metropolitan France. The data collected from March to December 2020 (19 survey waves), from a panel representative of the general population, were used. Three periods were defined: the first epidemic wave (March-April), the inter-wave period (May-June) and the second epidemic wave (November-December). A compliance score was constructed to measure systematic compliance with the five main measures. The association between systematic compliance and different variables (sociodemographic, mental health, level of health literacy, perceived severity of COVID-19, confidence in government, perceived effectiveness of the measures) was described using bivariate and multivariate logistic regression models, using the statistical software R. RESULTS Systematic compliance with the preventive measures changed over time. Regardless of the period, being a woman, being over 50, perceiving COVID-19 as severe, having a high level of health literacy or anxiety were positively associated with compliance. Having a child under 16 years of age and perceiving the measures as effective were positively associated with compliance with the protective measures during the epidemic waves; conversely, having a high level of depression, living alone, not working were negatively associated in the first epidemic wave. Finally, during the inter-wave period, living in an area heavily affected during the first wave and having a high level of education were positively and negatively associated with systematic compliance with the preventive measures, respectively. CONCLUSION The factors associated with compliance with the protective measures and social distancing evolved during the epidemic. Monitoring this evolution, in order to adapt communication and awareness strategies, is essential in the context of pandemic response.
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Affiliation(s)
- Clémentine Metzger
- Santé Publique France, Direction des Régions Grand-Est, Nancy, 54000, France.
| | - Jenifer Yaï
- Santé Publique France, Direction des Régions Grand-Est, Nancy, 54000, France
| | - Oriane Nassany
- Santé Publique France, Direction de la prévention et promotion de la santé, Saint-Maurice, 94410, France
| | - Sandrine Randriamampianina
- Santé Publique France, Direction de la prévention et promotion de la santé, Saint-Maurice, 94410, France
| | - Michel Vernay
- Santé Publique France, Direction des Régions Grand-Est, Nancy, 54000, France
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Hubbard G, Daas CD, Johnston M, Dunsmore J, Maier M, Polson R, Dixon D. Behavioural Sciences Contribution to Suppressing Transmission of Covid-19 in the UK: A Systematic Literature Review. Int J Behav Med 2024; 31:1-18. [PMID: 37059924 PMCID: PMC10104693 DOI: 10.1007/s12529-023-10171-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Governments have relied on their citizens to adhere to a variety of transmission-reducing behaviours (TRBs) to suppress the Covid-19 pandemic. Understanding the psychological and sociodemographic predictors of adherence to TRBs will be heavily influenced by the particular theories used by researchers. This review aims to identify the theories and theoretical constructs used to understand adherence to TRBs during the pandemic within the UK social and legislative context. METHODS A systematic review identified studies to understand TRBs of adults in the UK during the pandemic. Identified theoretical constructs were coded to the Theoretical Domains Framework. Data are presented as a narrative summary. RESULTS Thirty-five studies (n = 211,209) investigated 123 TRBs, applied 13 theoretical frameworks and reported 50 sociodemographic characteristics and 129 psychological constructs. Most studies used social cognition theories to understand TRBs and employed cross-sectional designs. Risk of sampling bias was high. Relationships between constructs and TRBs varied, but in general, beliefs about the disease (e.g. severity and risk perception) and about TRBs (e.g. behavioural norms) influenced behavioural intentions and self-reported adherence. More studies than not found that older people and females were more adherent. CONCLUSIONS Behavioural scientists in the UK generated a significant and varied body of work to understand TRBs during the pandemic. However, more use of theories that do not rely on deliberative processes to effect behaviour change and study designs better able to support causal inferences should be used in future to inform public health policy and practice. PROSPERO REGISTRATION CRD42021282699.
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Affiliation(s)
- Gill Hubbard
- Department of Nursing, University of the Highlands and Islands, Inverness, UK.
- Centre for Health Science, Older Perth Road, Inverness, IV2 3JH, UK.
| | - Chantal den Daas
- Health Psychology Group, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, Scotland
| | - Marie Johnston
- Health Psychology Group, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, Scotland
| | - Jennifer Dunsmore
- Health Psychology Group, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, Scotland
| | - Mona Maier
- Health Psychology Group, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, Scotland
| | - Rob Polson
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
| | - Diane Dixon
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
- School of Applied Sciences, Edinburgh Napier University, 9 Sighthill Court, EH11 4BN, Edinburgh, Scotland
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Liu J, Ouyang N, Mizrahi A, Kornides ML. Social Distancing in the COVID-19 Pandemic: Associated Factors, Health Outcomes, and Implications. FAMILY & COMMUNITY HEALTH 2024; 47:80-94. [PMID: 37681938 DOI: 10.1097/fch.0000000000000367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Social distancing has reemerged as a public health measure for containing the spread of COVID-19. This integrative review aims to analyze the historical use of social distancing, the current application during COVID-19, individual factors that affect social distancing practices, and consequential health outcomes. We analyzed relevant literature from searches conducted on Scopus, PubMed, and PsycINFO. We found that resources, culture, age, gender, and personality are associated with the degree to which people practice social distancing. Furthermore, social distancing changes our lifestyles and behavior and results in multifaceted health outcomes, including decreased physical activity and sunlight exposure, increased weight gain, and impaired sleep quality. On the positive side, social distancing has been linked to reduced crime rates and environmental damage, as well as better social and family ties. Future interventions may be utilized to increase adherence to social distancing practices and to mitigate the negative health effects of social distancing.
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Affiliation(s)
- Jianghong Liu
- Department of Family and Community Health, School of Nursing (Dr Liu), School of Nursing (Ms Ouyang and Dr Kornides), School of Arts and Sciences (Ms Mizrahi), University of Pennsylvania, Philadelphia; and Yale University, New Haven, Connecticut (Ms Ouyang)
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De Gaetano A, Bajardi P, Gozzi N, Perra N, Perrotta D, Paolotti D. Behavioral Changes Associated With COVID-19 Vaccination: Cross-National Online Survey. J Med Internet Res 2023; 25:e47563. [PMID: 37906219 PMCID: PMC10646669 DOI: 10.2196/47563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/05/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND During the initial phases of the vaccination campaign worldwide, nonpharmaceutical interventions (NPIs) remained pivotal in the fight against the COVID-19 pandemic. In this context, it is important to understand how the arrival of vaccines affected the adoption of NPIs. Indeed, some individuals might have seen the start of mass vaccination campaigns as the end of the emergency and, as a result, relaxed their COVID-safe behaviors, facilitating the spread of the virus in a delicate epidemic phase such as the initial rollout. OBJECTIVE The aim of this study was to collect information about the possible relaxation of protective behaviors following key events of the vaccination campaign in four countries and to analyze possible associations of these behavioral tendencies with the sociodemographic characteristics of participants. METHODS We developed an online survey named "COVID-19 Prevention and Behavior Survey" that was conducted between November 26 and December 22, 2021. Participants were recruited using targeted ads on Facebook in four different countries: Brazil, Italy, South Africa, and the United Kingdom. We measured the onset of relaxation of protective measures in response to key events of the vaccination campaign, namely personal vaccination and vaccination of the most vulnerable population. Through calculation of odds ratios (ORs) and regression analysis, we assessed the strength of association between compliance with NPIs and sociodemographic characteristics of participants. RESULTS We received 2263 questionnaires from the four countries. Participants reported the most significant changes in social activities such as going to a restaurant or the cinema and visiting relatives and friends. This is in good agreement with validated psychological models of health-related behavioral change such as the Health Belief Model, according to which activities with higher costs and perceived barriers (eg, social activities) are more prone to early relaxation. Multivariate analysis using a generalized linear model showed that the two main determinants of the drop of social NPIs were (1) having previously tested positive for COVID-19 (after the second vaccine dose: OR 2.46, 95% CI 1.73-3.49) and (2) living with people at risk (after the second vaccine dose: OR 1.57, 95% CI 1.22-2.03). CONCLUSIONS This work shows that particular caution has to be taken during vaccination campaigns. Indeed, people might relax their safe behaviors regardless of the dynamics of the epidemic. For this reason, it is crucial to maintain high compliance with NPIs to avoid hindering the beneficial effects of the vaccine.
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Affiliation(s)
- Alessandro De Gaetano
- ISI Foundation, Turin, Italy
- Aix Marseille Univ, Université de Toulon, CNRS, CPT, Marseille, France
| | - Paolo Bajardi
- ISI Foundation, Turin, Italy
- CENTAI Institute, Turin, Italy
| | - Nicolò Gozzi
- ISI Foundation, Turin, Italy
- Networks and Urban Systems Centre, University of Greenwich, London, United Kingdom
| | - Nicola Perra
- Networks and Urban Systems Centre, University of Greenwich, London, United Kingdom
- School of Mathematical Sciences, Queen Mary University of London, London, United Kingdom
| | - Daniela Perrotta
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
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Mongin D, Buclin CP, Cullati S, Courvoisier DS. COVID-19 Vaccination Rate under Different Political Incentive: A Counterfactual Trend Approach Using Nationwide Data. Vaccines (Basel) 2023; 11:1149. [PMID: 37514965 PMCID: PMC10385043 DOI: 10.3390/vaccines11071149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: France implemented a COVID-19 certificate in July 2021 to incentivize the population to uptake COVID-19 vaccines. However, little is known about the variation in its impact across age groups and its dependence on socio-demographic, economic, logistic, or political factors. (2) Methods: Using France's weekly first dose vaccination rate, a counterfactual trend approach allowed for the estimation of the vaccination rate across age groups at a small geographical level before and after the implementation of the health pass. The effect of the health pass was operationalized as the vaccination rate among those who would not be vaccinated without it. (3) Results: Vaccination before the health pass varied greatly among age groups and was mainly influenced by territory (lower in rural and overseas territories when compared to urban and metropolitan ones), political beliefs, and socio-economic disparities. Vaccine logistics played a minor but significant role, while the impact of COVID-19 did not affect the vaccination rate. The health pass increased the vaccination overall but with varying efficiency across groups. It convinced mainly young people politically close to the governmental vaccination strategy and living in urban metropolitan areas with low socio-economical discrepancies. The selected variables explained most of the variability of the vaccination rate before the health pass; they explained, at most, a third of the variation in the health pass effect on vaccination. (4) Conclusions: From a public health perspective, the French health pass increased the overall vaccination, but failed to promote preventive behaviours in all segments of society, particularly in vulnerable communities.
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Affiliation(s)
- Denis Mongin
- Faculty of Medicine, University of Geneva, CH-1211 Geneva, Switzerland
| | - Clement P Buclin
- Faculty of Medicine, University of Geneva, CH-1211 Geneva, Switzerland
| | - Stephane Cullati
- Division Quality of Care, Geneva University Hospitals, CH-1211 Geneva, Switzerland
- Population Health Laboratory (#PopHealthLab), Faculty of Science and Medicine, University of Fribourg, CH-1700 Fribourg, Switzerland
| | - Delphine S Courvoisier
- Faculty of Medicine, University of Geneva, CH-1211 Geneva, Switzerland
- Division Quality of Care, Geneva University Hospitals, CH-1211 Geneva, Switzerland
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Zuñiga RAA, Melendez CAC, Folayan MO, Brown B, El Tantawi M, Aly NM, Abeldaño GF, Miranda KA, Ara E, Ellakany P, Al-Khanati NM, Khan ATA, Lawal FB, Lusher J, Nzimande NP, Popoola BO, Virtanen J, Ndembi N, Nguyen AL. Social media information and its association with the adoption of COVID-19 preventive measures in four Latin American countries. THE REVIEW OF COMMUNICATION 2023; 23:247-262. [PMID: 38106967 PMCID: PMC10722885 DOI: 10.1080/15358593.2023.2174382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 01/25/2023] [Indexed: 12/19/2023]
Abstract
Objective The study aimed to assess the association between adherence to COVID-19 preventive measures and access to media information related to COVID-19. Methods A multi-country, cross-sectional study using an online survey was conducted from June to December 2020. The sample included 1,457 participants from Argentina, Brazil, Chile, and Mexico. The outcome variable was self-reported adherence to preventive measures (handwashing, social distancing, self-isolation, use of face masks, and working from home). The explanatory variable was self-report of following media information related to COVID-19 (watching or reading the news, following social media coverage). Multivariable logistic regression analyses were conducted to determine the associations. Results Following information on social media was positively associated with higher odds of practicing social distancing (AOR=5.39; 95%CI: 3.93-7.30), self-isolation (AOR=1.44; 95%CI: 1.08-1.92), use of face masks (AOR=16.84; 95%CI: 10.03-28.27), handwashing (AOR=6.95; CI 95%: 4.98-9.71), and working from home (AOR=1.85; 95% CI: 1.43-2.41). Differences in the use of social media for COVID-19 information were observed among the four countries. Conclusion Following social media was positively associated with adherence to COVID-19 preventive measures in Latin America. Social media may be effectively used for COVID-19 behaviour modification in Latin America.
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Affiliation(s)
| | | | - Morenike Oluwatoyin Folayan
- Mental Health and Wellness Study Group
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Brandon Brown
- Mental Health and Wellness Study Group
- Department of Social Medicine, Population and Public Health, University of California, Riverside, CA, USA
| | - Maha El Tantawi
- Mental Health and Wellness Study Group
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Nourhan M. Aly
- Mental Health and Wellness Study Group
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | | | - Kessketlen Alves Miranda
- Mental Health and Wellness Study Group
- Research Centre in Physical Activity, Health and Leisure, University of Porto, Portugal
| | - Eshrat Ara
- Mental Health and Wellness Study Group
- Government College for Women, Maulana Azad Road Srinagar Kashmir (J&K), India
| | - Passent Ellakany
- Mental Health and Wellness Study Group
- Department of Substantive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nuraldeen Maher Al-Khanati
- Mental Health and Wellness Study Group
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Syrian Private University, Damascus, Syria
| | - Abeedha Tu-Allah Khan
- Mental Health and Wellness Study Group
- School of Biological Sciences, University of the Punjab, Lahore, Punjab, Pakistan
| | - Folake Barakat Lawal
- Mental Health and Wellness Study Group
- Department of Periodontology and Community Dentistry, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Joanne Lusher
- Mental Health and Wellness Study Group
- School of Health and Life Sciences, University of the West of Scotland
| | - Ntombifuthi P. Nzimande
- Mental Health and Wellness Study Group
- Department of Economic and Human Geography, University of Szeged, Szeged, Hungary
| | - Bamidele Olubukola Popoola
- Mental Health and Wellness Study Group
- Department of Child Oral Health, University of Ibadan, Ibadan, Nigeria
| | - Jorma Virtanen
- Mental Health and Wellness Study Group
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Nicaise Ndembi
- Mental Health and Wellness Study Group
- Africa Centres for Disease Control and Prevention, African Union Commission, Addis Ababa, Ethiopia
| | - Annie Lu Nguyen
- Mental Health and Wellness Study Group
- Department of Family Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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COVID-19-Related Awareness and Behaviors of Non-Saudi Travelers and Their Satisfaction with Preventive Measures at Saudi Airports. Trop Med Infect Dis 2022; 7:tropicalmed7120435. [PMID: 36548690 PMCID: PMC9780880 DOI: 10.3390/tropicalmed7120435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
Airports could serve as hotspots for the spread of the COVID-19 infection. We aimed to assess the awareness, attitude, and behaviors of non-Saudi travelers about COVID-19 and their satisfaction with preventive measures at Saudi airports. A cross-sectional study was conducted among non-Saudi travelers arriving in Saudi Arabia at two international airports. Data were collected using a questionnaire in Arabic, Hindi, and Urdu languages. Awareness, attitude, behavior scores, and satisfaction levels were calculated. Linear regression analyses were done to assess the predictors of awareness, attitude, and behaviors. A total of 633 participants were included in the study. The mean awareness, attitude, and behavior scores were 16.3/22, 18.3/24, and 3.2/5, respectively. Nationality, education, and income were significant predictors of awareness. Nationality was the only significant predictor of attitude, while gender and nationality were predictors of behaviors. Overall satisfaction with preventive measures was: transportation (94%), lounges and corridors (96%), counters (98%), and airport staff (97%). There was overall good awareness and attitude among travelers. Behavior scores were relatively low, which needs to change as air travel poses a threat to the spread of infectious diseases. Airport authorities need to manage passengers properly to ensure adequate distancing to prevent the potential transmission of infections.
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Future behaviours decision-making regarding travel avoidance during COVID-19 outbreaks. Sci Rep 2022; 12:19780. [PMID: 36396687 PMCID: PMC9671889 DOI: 10.1038/s41598-022-24323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Human behavioural changes are poorly understood, and this limitation has been a serious obstacle to epidemic forecasting. It is generally understood that people change their respective behaviours to reduce the risk of infection in response to the status of an epidemic or government interventions. We must first identify the factors that lead to such decision-making to predict these changes. However, due to an absence of a method to observe decision-making for future behaviour, understanding the behavioural responses to disease is limited. Here, we show that accommodation reservation data could reveal the decision-making process that underpins behavioural changes, travel avoidance, for reducing the risk of COVID-19 infections. We found that the motivation to avoid travel with respect to only short-term future behaviours dynamically varied and was associated with the outbreak status and/or the interventions of the government. Our developed method can quantitatively measure and predict a large-scale population's behaviour to determine the future risk of COVID-19 infections. These findings enable us to better understand behavioural changes in response to disease spread, and thus, contribute to the development of reliable long-term forecasting of disease spread.
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Buzzin A, Domènech-Gil G, Fraschetti E, Giovine E, Puglisi D, Caputo D. Assessing the consequences of prolonged usage of disposable face masks. Sci Rep 2022; 12:16796. [PMID: 36207345 PMCID: PMC9540090 DOI: 10.1038/s41598-022-20692-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Due to the SARS-CoV-2 outbreak, wearing a disposable face mask has become a worldwide daily routine, not only for medical operators or specialized personnel, but also for common people. Notwithstanding the undeniable positive effect in reducing the risk of virus transmission, it is important to understand if a prolonged usage of the same face mask can have effectiveness on filtering capability and potential health consequences. To this aim, we present three investigations. A survey, carried out in central Italy, offers an overview of the distorted public awareness of face mask usage. A functional study shows how prolonged wearing leads to substantial drops in humid air filtration efficiency. Finally, a morphological analysis reports the proliferation of fungal or bacteria colonies inside an improperly used mask. Our study highlights therefore that wearing a face mask is really beneficial only if it is used correctly.
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Affiliation(s)
- Alessio Buzzin
- Department of Information Engineering, Electronics and Telecommunications, Sapienza University of Rome, via Eudossiana, 18 00184, Rome, Italy
| | - Guillem Domènech-Gil
- Department of Physics, Chemistry and Biology, Sensor and Actuator Systems Division, Linköping University, Campus Valla, 581 83, Linköping, Sweden
| | - Elena Fraschetti
- Department of Information Engineering, Electronics and Telecommunications, Sapienza University of Rome, via Eudossiana, 18 00184, Rome, Italy
| | - Ennio Giovine
- Institute for Photonics and Nanotechnologies, IFN - CNR, Via Cineto Romano 42, 00156, Rome, Italy
| | - Donatella Puglisi
- Department of Physics, Chemistry and Biology, Sensor and Actuator Systems Division, Linköping University, Campus Valla, 581 83, Linköping, Sweden.
| | - Domenico Caputo
- Department of Information Engineering, Electronics and Telecommunications, Sapienza University of Rome, via Eudossiana, 18 00184, Rome, Italy.
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Institutional Reconstruction of Promoting and Maintaining the Level of Compliance with Health Protocols in Indonesia during the Pandemic. SYSTEMIC PRACTICE AND ACTION RESEARCH 2022; 36:377-406. [PMID: 36097607 PMCID: PMC9453723 DOI: 10.1007/s11213-022-09611-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
This article aimed to observe the efforts of Indonesia and the problems faced in fighting the COVID-19 pandemic regarding the indecisive public policy and the reluctance of people from all walks of life to comply with the Health Protocols (HP) from the perspective of sociological institutionalism (Nee 2003; Nee and Opper 2015). A two-step variant of SSM-based multi method by Muhammaditya et al. (2021) was applied by inserting (1) Textual Network Analysis by Segev (2020) at stage 1 of SSM to obtain an insightful understanding of the problem situation and to enrich the rich picture, and (2) Social Network Analysis at stage 5 of SSM to expand a skillful discussion on the reality. The research novelty was elaborated in four main empirical facts: First, government policies had initially faltered in dealing with the pandemic, reflected by the dissonance in the statements made by high-ranking state officials. Second, there was a great number of people disregarding HP and pandemic mitigation policies, particularly during annual rites, the end of year celebration, and Eid Al-Fitr. Third, the government encountered a dilemma in issuing policies, whether to remain encouraging economic growth, guarantee the continuity of economic activities, or end the spread of COVID-19. Fourth, the direct involvement of the president in handling COVID-19 had a significant impact in reducing active cases that no province was declared as alert areas in October 2021. Meanwhile, the methodological novelty reflected in broader data and analysis through SNA and TNA methods had enriched the practice of SSM in finding sharper conclusions.
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Trust in the public health system as a source of information on vaccination matters most when environments are supportive. Vaccine 2022; 40:4693-4699. [PMID: 35753840 DOI: 10.1016/j.vaccine.2022.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/06/2022] [Accepted: 06/02/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To understand whether health insurance coverage of vaccine costs and discussing vaccination with a healthcare provider are necessary for trust in CDC (Centers for Disease Control) to increase the uptake of the vaccine. METHOD A nationally representative sample of 2,549 adults from the United States answered questions about trust in CDC, insurance coverage, interactions with healthcare providers, and risk perceptions, and then provided longitudinal reports of actual vaccination against influenza during the course of the 2018-19 flu season. RESULTS Trust in CDC as a source of information on vaccines was a strong precursor of vaccination. According to multilevel regressions, however, this effect was localized to respondents who had insurance coverage or whose providers discussed the vaccine with them. Further, the effect of trust was even stronger when both insurance coverage and healthcare provider discussions were present. CONCLUSIONS Environmental factors supportive of vaccination increased the positive influence of trust in CDC on vaccine uptake by almost 50 percent. Insurance companies and healthcare providers can promote vaccination by covering the costs of vaccination and discussing vaccines in personalized conversations with patients.
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de Andrés-Sánchez J, Arias-Oliva M, Pelegrin-Borondo J. Citizens’ Perception of COVID-19 Passport Usefulness: A Cross Sectional Study. Behav Sci (Basel) 2022; 12:bs12050140. [PMID: 35621437 PMCID: PMC9137592 DOI: 10.3390/bs12050140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/03/2022] [Accepted: 05/11/2022] [Indexed: 02/05/2023] Open
Abstract
This paper assesses the influence on people’s perception of the utility of the immunity passport (IP) program by sociodemographic factors, infectivity status, and the objective of its use. The material of this paper is a cross-sectional survey of 400 residents in Spain. The relation between utility perception and input variables is fitted with ordinary least squares (OLS) regression and linear quantile regression (LQR). The principal explanatory variable of usefulness perception is being vaccinated, especially when the objective of the IP is regulating mobility. The OLS estimate of the coefficient regression is (cr) = 0.415 (p = 0.001). We also found a positive and significant influence of that factor in all LQRs (cr = 0.652, p = 0.0026 at level (τ) = 0.75; cr = 0.482, p = 0.0047 at τ = 0.5 and cr = 0.201, p = 0.0385 at τ = 0.25). When the objective of the IP is regulating leisure, being vaccinated is relevant only to explain the central measures of usefulness perception. If the IP is used to regulate traveling, variables related to interviewees’ infectivity have greater relevance than sociodemographic factors. When its objective is ruling assembly, the more important variables than being vaccinated are gender and age. To create an effective implementation of the IP, it is advisable to have a general agreement among the population on its convenience. Therefore, the findings in this study have important implications for public health decision-makers.
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Affiliation(s)
- Jorge de Andrés-Sánchez
- Department of Business Management, Social & Business Research Laboratory, Universitat Rovira i Virgili, 43002 Tarragona, Spain;
- Correspondence: ; Tel.: +34-977759833
| | - Mario Arias-Oliva
- Department of Business Management, Social & Business Research Laboratory, Universitat Rovira i Virgili, 43002 Tarragona, Spain;
- Management and Marketing Department, Complutense University of Madrid, 28040 Madrid, Spain
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Calder G, Radic A, Ryu HB, Ariza-Montes A, Han H. COVID-19 and Pro-environmental Behaviour at Destinations Amongst International Travellers. Front Psychol 2022; 13:879300. [PMID: 35496140 PMCID: PMC9047711 DOI: 10.3389/fpsyg.2022.879300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
This paper investigates the COVID-19 pandemic, and its impact on pro-environmental behaviour of individuals travelling internationally for leisure and recreational purposes. The aim of this manuscript is to investigate a conceptual framework created through the examination of current existing literature in the field of tourism science. The conceptual framework, consisting of certain constructs of the health belief model (HBM), and the theory of planned behaviour (TPB), is applied and tested using a partial least-squares-structural equation modelling (PLS-SEM). Data were collected from participants who have travelled internationally before and during the outbreak of the COVID-19 pandemic, and those who plan to travel post-COVID-19 pandemic. Results revealed that the conceptual framework tested positively against existing theory, highlighting the key influencing factors in which COVID-19 is likely to have on future pro-environmental behaviour of individuals travelling internationally for leisure and recreational purposes. Moreover, perceived safety threat and outcome expectations have a positive impact on attitude; attitude has a positive impact on behavioural intentions; subjective norm has a positive impact on behavioural intentions, and perceived behavioural control has a positive impact on behavioural intentions. The study results identify practical and theoretical implications for global and travel companies and organisations, presenting opportunities to adjust environmental policies and procedures accordingly, whilst identifying the most effective marketing and management strategies to rebuild a collapsed global travel industry.
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Affiliation(s)
- Gary Calder
- Independent Researcher, Dundee, United Kingdom
| | | | - Hyungseo Bobby Ryu
- Department of Food Franchise, College of Health Sciences, Kyungnam University, Changwon, South Korea
- *Correspondence: Hyungseo Bobby Ryu,
| | | | - Heesup Han
- College of Hospitality and Tourism Management, Sejong University, Seoul, South Korea
- Heesup Han,
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Saha SK, Adhikary A, Jha A. Enhancement in medication adherence amidst COVID-19 using active reminders. THE EUROPEAN PHYSICAL JOURNAL. SPECIAL TOPICS 2022; 231:3497-3504. [PMID: 35308810 PMCID: PMC8917334 DOI: 10.1140/epjs/s11734-022-00532-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/05/2022] [Indexed: 06/14/2023]
Abstract
UNLABELLED The aim of this study is to enhance medication adherence amidst COVID-19 with the help of active reminders. Effect of: patients' perception of side effect, importance of physicians' instructions, and their beliefs, on medication adherence were measured. Sample size was 583. The study was conducted in the state of Sikkim in India. Responses were analyzed and a structural equation model was framed to test the paths. It was found that reminders had a significant impact on patients' perception about importance given to physician instruction ( β = 0.433 ) and their beliefs ( β = 0.224 ). These mediators helped to increase the adherence rate of patients. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1140/epjs/s11734-022-00532-7.
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Affiliation(s)
- Saibal Kumar Saha
- Department of Management Studies, Sikkim Manipal Institute of Technology, Sikkim Manipal University, Sikkim, India
| | - Anindita Adhikary
- Department of Management Studies, Sikkim Manipal Institute of Technology, Sikkim Manipal University, Sikkim, India
| | - Ajeya Jha
- Department of Management Studies, Sikkim Manipal Institute of Technology, Sikkim Manipal University, Sikkim, India
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15
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Perceptions of COVID-19 Mitigation Strategies between Rural and Non-Rural Adults in the US: How Public Health Nurses Can Fill the Gap. NURSING REPORTS 2022; 12:188-197. [PMID: 35324565 PMCID: PMC8954485 DOI: 10.3390/nursrep12010019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to capture the perceptions of COVID-19 mitigations’ efficacy of rural and non-rural participants, using the health belief model (HBM), as well as to describe where public health nursing may be able to fill behavior gaps in rural communities. Rural and non-rural participants completed electronic surveys. Surveys collected demographic information and perceptions of various mitigation strategies’ effectiveness. Rurality was significantly associated with perceptions of the effectiveness of public health mitigation strategies including wearing facemasks, limiting time indoors, avoiding gatherings, non-essential business closure, and staying home. Our findings suggest people in rural areas perceive mitigations to be effective. Other researchers have consistently shown rural residents are least likely to partake in the same mitigations. Rural public health nurses on the front line serve as the key to closing the aforementioned gap. Understanding where their community’s perceptions lie is pivotal in creating educational programs to continue mitigation efforts as we embark on the second year of this pandemic.
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16
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The impact of control and mitigation strategies during the second wave of coronavirus infections in Spain and Italy. Sci Rep 2022; 12:1073. [PMID: 35058522 PMCID: PMC8776768 DOI: 10.1038/s41598-022-05041-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/30/2021] [Indexed: 12/22/2022] Open
Abstract
European countries struggled to fight against the second and the third waves of the COVID-19 pandemic, as the Test-Trace-Isolate (TTI) strategy widely adopted over the summer and early fall 2020 failed to contain the spread of the disease effectively. This paper sheds light on the effectiveness of such a strategy in two European countries (Spain and Italy) by analysing data from June to December 2020, collected via a large-scale online citizen survey with 95,251 and 43,393 answers in Spain and Italy, respectively. Our analysis describes several weaknesses in each of the three pillars of the TTI strategy: Test, Trace, and Isolate. We find that 40% of respondents had to wait more than 48 hours to obtain coronavirus tests results, while literature has shown that a delay of more than one day might make tracing all cases inefficient. We also identify limitations in the manual contact tracing capabilities in both countries, as only 29% of respondents in close contact with a confirmed infected individual reported having been contact traced. Moreover, our analysis shows that more than 45% of respondents report being unable to self-isolate if needed. We also analyse the mitigation strategies deployed to contain the second wave of coronavirus. We find that these interventions were particularly effective in Italy, where close contacts were reduced by more than 20% in the general population. Finally, we analyse the participants’ perceptions about the coronavirus risk associated with different daily activities. We observe that they are often gender- and age-dependent, and not aligned with the actual risk identified by the literature. This finding emphasises the importance of deploying public-health communication campaigns to debunk misconceptions about SARS-CoV-2. Overall, our work illustrates the value of online citizen surveys to quickly and efficiently collect large-scale population data to support and evaluate policy decisions to combat the spread of infectious diseases, such as coronavirus.
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17
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Liu F, Fang M, Cai L, Su M, Wang X. Consumer Motivations for Adopting Omnichannel Retailing: A Safety-Driven Perspective in the Context of COVID-19. Front Public Health 2022; 9:708199. [PMID: 35096722 PMCID: PMC8793021 DOI: 10.3389/fpubh.2021.708199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/20/2021] [Indexed: 12/28/2022] Open
Abstract
This study aims to understand the influence of COVID-19 on consumers' fears and self-protection motivations. Furthermore, the study seeks to understand the effects of these fears and motivations on consumers' intentions to use omnichannel retailing. A modified theoretical model is proposed by integrating protection motivation theory (PMT) and extending the extended parallel process model (E-EPPM). A total of 398 valid questionnaires are collected and used for further structural equation modeling analysis. The results suggest that the perceived severity, perceived vulnerability, and health anxiety positively impact perceived fears surrounding COVID-19. Furthermore, it is found that perceived fear, self-efficacy, and response efficacy will affect the protection motivation of consumers and ultimately contribute to their behavioral intention to use omnichannel retailing. The findings theoretically enrich the research on COVID-19, PMT, and E-EPPM and empirically provide managerial implications for omnichannel retail service providers.
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Affiliation(s)
- Feng Liu
- Business School, Shandong University, Weihai, China
| | - Mingjie Fang
- Department of Logistics, Service & Operations Management, Korea University Business School, Seoul, South Korea
- *Correspondence: Mingjie Fang
| | - Lanhui Cai
- Department of International Logistics, Chung-Ang University, Seoul, South Korea
| | - Miao Su
- Department of International Logistics, Chung-Ang University, Seoul, South Korea
| | - Xueqin Wang
- Department of International Logistics, Chung-Ang University, Seoul, South Korea
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18
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Del Fava E, Cimentada J, Perrotta D, Grow A, Rampazzo F, Gil-Clavel S, Zagheni E. Differential impact of physical distancing strategies on social contacts relevant for the spread of SARS-CoV-2: evidence from a cross-national online survey, March-April 2020. BMJ Open 2021; 11:e050651. [PMID: 34675016 PMCID: PMC8532142 DOI: 10.1136/bmjopen-2021-050651] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We investigate changes in social contact patterns following the gradual introduction of non-pharmaceutical interventions and their implications for infection transmission in the early phase of the pandemic. DESIGN, SETTING AND PARTICIPANTS We conducted an online survey based on targeted Facebook advertising campaigns across eight countries (Belgium, France, Germany, Italy, the Netherlands, Spain, UK and USA), achieving a sample of 51 233 questionnaires in the period 13 March-12 April 2020. Poststratification weights based on census information were produced to correct for selection bias. OUTCOME MEASURES Participants provided data on social contact numbers, adoption of protective behaviours and perceived level of threat. These data were combined to derive a weekly index of infection transmission, the net reproduction number [Formula: see text] . RESULTS Evidence from the USA and UK showed that the number of daily contacts mainly decreased after governments issued the first physical distancing guidelines. In mid-April, daily social contact numbers had decreased between 61% in Germany and 87% in Italy with respect to pre-COVID-19 levels, mostly due to a contraction in contacts outside the home. Such reductions, which were uniform across age groups, were compatible with an [Formula: see text] equal or smaller than one in all countries, except Germany. This indicates lower levels of infection transmission, especially in a period of gradual increase in the adoption rate of the face mask outside the home. CONCLUSIONS We provided a comparable set of statistics on social contact patterns during the COVID-19 pandemic for eight high-income countries, disaggregated by week and other demographic factors, which could be leveraged by the scientific community for developing more realistic epidemic models of COVID-19.
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Affiliation(s)
- Emanuele Del Fava
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Jorge Cimentada
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Daniela Perrotta
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
| | - André Grow
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Francesco Rampazzo
- Saïd Business School, Leverhulme Centre for Demographic Science, and Nuffield College, University of Oxford, Oxford, UK
| | - Sofia Gil-Clavel
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Emilio Zagheni
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
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19
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Nawaz SA, Li J, Bhatti UA, Bazai SU, Zafar A, Bhatti MA, Mehmood A, Ain QU, Shoukat MU. A hybrid approach to forecast the COVID-19 epidemic trend. PLoS One 2021; 16:e0256971. [PMID: 34606503 PMCID: PMC8489714 DOI: 10.1371/journal.pone.0256971] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/19/2021] [Indexed: 12/02/2022] Open
Abstract
Studying the progress and trend of the novel coronavirus pneumonia (COVID-19) transmission mode will help effectively curb its spread. Some commonly used infectious disease prediction models are introduced. The hybrid model is proposed, which overcomes the disadvantages of the logistic model's inability to predict the number of confirmed diagnoses and the drawbacks of too many tuning parameters of the SEIR (Susceptible, Exposed, Infectious, Recovered) model. The realization and superiority of the prediction of the proposed model are proven through experiments. At the same time, the influence of different initial values of the parameters that need to be debugged on the hybrid model is further studied, and the mean error is used to quantify the prediction effect. By forecasting epidemic size and peak time and simulating the effects of public health interventions, this paper aims to clarify the transmission dynamics of COVID-19 and recommend operation suggestions to slow down the epidemic. It is suggested that the quick detection of cases, sufficient implementation of quarantine and public self-protection behaviours are critical to slow down the epidemic.
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Affiliation(s)
- Saqib Ali Nawaz
- College of Information and Communication Engineering, Hainan University, Haikou, China
- State Key Laboratory of Marine Resource Utilization in the South China Sea, Hainan University, Haikou, China
| | - Jingbing Li
- College of Information and Communication Engineering, Hainan University, Haikou, China
- State Key Laboratory of Marine Resource Utilization in the South China Sea, Hainan University, Haikou, China
| | - Uzair Aslam Bhatti
- School of Geography (Remote Sensing), Nanjing Normal University, Nanjing, Jiangsu, China
| | | | - Asmat Zafar
- General Nursing College DHQ Hospital, Jhang, Pakistan
| | - Mughair Aslam Bhatti
- School of Geography (Remote Sensing), Nanjing Normal University, Nanjing, Jiangsu, China
| | - Anum Mehmood
- Medical School of Southeast University, Nanjing, P.R. China
| | - Qurat ul Ain
- School of Geography (Remote Sensing), Nanjing Normal University, Nanjing, Jiangsu, China
| | - Muhammad Usman Shoukat
- School of Automation and Information, Sichuan University of Science and Engineering, Yibin, China
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20
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Ma R, Wu H, Deng Z. Identify and measure the degree of over-prevention behaviors in the post-COVID-19 era in China. BMC Public Health 2021; 21:1743. [PMID: 34563147 PMCID: PMC8466653 DOI: 10.1186/s12889-021-11823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background With the spread of vaccines, more and more countries have controlled the outbreak of the COVID-19. In this post-epidemic era, these countries began to revive their economy. However, pollution remains in the environment, and people’s physical and psychological health has been under threat due to some over-prevention behaviors. Instruments for governmental agencies to manage these behaviors are not yet available. This study aims to develop a measurement model to identify and measure the degree of over-prevention behaviors during the COVID-19 epidemic in China. Methods A survey online was conducted to collect cognition from 1528 Chinese people, including descriptions of various over-prevention behaviors defined by health authorities. Factor analyses were used to develop the measurement model and test its validity. Logistic regression analyses were conducted to explore demographic characteristics, indicating people who are inclined to exhibit over-prevention behaviors. Results Four main factors were extracted to develop the model (eigenvalue = 7.337, 3.157, 1.447, and 1.059, respectively). The overall reliability (Cronbach’s α = 0.900), the convergent (AVE > 0.5, CR > 0.8 for each factor) and discriminant validity is good. There is also a good internal consistency among these factors (Cronbach’s α = 0.906, 0.852, 0.882, and 0.763, respectively). In Factor 1, gender has a negative effect (Beta = − 0.294, P < 0.05, OR = 0.745), whereas employment has a positive effect. Workers in institutions exhibit the greatest effect (Beta = 0.855, P < 0.001, OR = 2.352). In Factor 2, employment has a negative effect, with workers in institutions exhibit the greatest role (Beta = − 0.963, P < 0.001, OR = 0.382). By contrast, education level has a positive effect (Beta = 0.430, P < 0.001, OR = 1.537). In Factor 3, age plays a negative role (Beta = − 0.128, P < 0.05, OR = 0.880). Conclusions People show a discrepancy in the cognition toward various over-prevention behaviors. The findings may have implications for decision-makers to reduce the contradiction between the epidemic and economic revival via managing these behaviors.
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Affiliation(s)
- Rongyang Ma
- School of Medicine and Health Management, Huazhong University of Science and Technology, No. 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China
| | - Hong Wu
- School of Medicine and Health Management, Huazhong University of Science and Technology, No. 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China.
| | - Zhaohua Deng
- School of Management, Huazhong University of Science and Technology, Wuhan, China
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21
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Gauvin L, Bajardi P, Pepe E, Lake B, Privitera F, Tizzoni M. Socio-economic determinants of mobility responses during the first wave of COVID-19 in Italy: from provinces to neighbourhoods. J R Soc Interface 2021; 18:20210092. [PMID: 34343450 PMCID: PMC8331235 DOI: 10.1098/rsif.2021.0092] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/06/2021] [Indexed: 02/07/2023] Open
Abstract
After more than 1 year into the COVID-19 pandemic, governments worldwide still face the challenge of adopting non-pharmaceutical interventions to mitigate the risks posed by the emergence of new SARS-CoV-2 variants and the lack of a worldwide equitable vaccine allocation. Thus, it becomes crucial to identify the drivers of mobility responses to mitigation efforts during different restriction regimes, for planning interventions that are both economically and socially sustainable while effective in controlling an outbreak. Here, using anonymous and privacy-enhanced cell phone data from Italy, we investigate the determinants of spatial variations of reductions in mobility and co-location in response to the adoption and the lift of restrictions, considering both provinces and city neighbourhoods. In large urban areas, our analysis uncovers the desertification of historic city centres, which persisted after the end of the lockdown. Such centre-periphery gradient was mainly associated with differences in educational attainment. At the province level, the local structure of the labour market mainly explained the variations in mobility responses, together with other demographic factors, such as the population's age and sex composition. In the future, targeted interventions should take into account how the ability to comply with restrictions varies across geographical areas and socio-demographic groups.
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22
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Escandón K, Rasmussen AL, Bogoch II, Murray EJ, Escandón K, Popescu SV, Kindrachuk J. COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection. BMC Infect Dis 2021; 21:710. [PMID: 34315427 PMCID: PMC8314268 DOI: 10.1186/s12879-021-06357-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Scientists across disciplines, policymakers, and journalists have voiced frustration at the unprecedented polarization and misinformation around coronavirus disease 2019 (COVID-19) pandemic. Several false dichotomies have been used to polarize debates while oversimplifying complex issues. In this comprehensive narrative review, we deconstruct six common COVID-19 false dichotomies, address the evidence on these topics, identify insights relevant to effective pandemic responses, and highlight knowledge gaps and uncertainties. The topics of this review are: 1) Health and lives vs. economy and livelihoods, 2) Indefinite lockdown vs. unlimited reopening, 3) Symptomatic vs. asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) Droplet vs. aerosol transmission of SARS-CoV-2, 5) Masks for all vs. no masking, and 6) SARS-CoV-2 reinfection vs. no reinfection. We discuss the importance of multidisciplinary integration (health, social, and physical sciences), multilayered approaches to reducing risk ("Emmentaler cheese model"), harm reduction, smart masking, relaxation of interventions, and context-sensitive policymaking for COVID-19 response plans. We also address the challenges in understanding the broad clinical presentation of COVID-19, SARS-CoV-2 transmission, and SARS-CoV-2 reinfection. These key issues of science and public health policy have been presented as false dichotomies during the pandemic. However, they are hardly binary, simple, or uniform, and therefore should not be framed as polar extremes. We urge a nuanced understanding of the science and caution against black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches. There is a need for meaningful public health communication and science-informed policies that recognize shades of gray, uncertainties, local context, and social determinants of health.
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Affiliation(s)
- Kevin Escandón
- School of Medicine, Universidad del Valle, Cali, Colombia.
| | - Angela L Rasmussen
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
| | - Isaac I Bogoch
- Division of Infectious Diseases, University of Toronto, Toronto General Hospital, Toronto, Canada
| | - Eleanor J Murray
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Karina Escandón
- Department of Anthropology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Saskia V Popescu
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Jason Kindrachuk
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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23
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Berman AH, Bendtsen M, Molander O, Lindfors P, Lindner P, Granlund L, Topooco N, Engström K, Andersson C. Compliance with recommendations limiting COVID-19 contagion among university students in Sweden: associations with self-reported symptoms, mental health and academic self-efficacy. Scand J Public Health 2021; 50:70-84. [PMID: 34213359 PMCID: PMC8808007 DOI: 10.1177/14034948211027824] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIMS The COVID-19 containment strategy in Sweden uses public health recommendations relying on personal responsibility for compliance. Universities were one of few public institutions subject to strict closure, meaning that students had to adapt overnight to online teaching. This study investigates the prevalence of self-reported recommendation compliance and associations with self-reported symptoms of contagion, self-experienced effects on mental health and academic self-efficacy among university students in Sweden in May-June 2020. METHODS This was a cross-sectional 23 question online survey in which data were analysed by multinomial regression, taking a Bayesian analysis approach complemented by null hypothesis testing. RESULTS A total of 4495 students consented to respond. Recommendation compliance ranged between 70% and 96%. Women and older students reported higher compliance than did men and younger students. Mild to moderate COVID-19 symptoms were reported by 30%, severe symptoms by fewer than 2%; 15% reported being uncertain and half of the participants reported no symptoms. Mental health effects were reported by over 80%, and changes in academic self-efficacy were reported by over 85%; in both these areas negative effects predominated. Self-reported symptoms and uncertainty about contagion were associated with non-compliance, negative mental health effects, and impaired academic self-efficacy. CONCLUSIONS Students generally followed public health recommendations during strict closure of universities, but many reported considerable negative consequences related to mental health and academic self-efficacy. Digital interventions should be developed and evaluated to boost coping skills, build resilience and alleviate student suffering during the pandemic and future similar crises.
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Affiliation(s)
- Anne H. Berman
- Department of Psychology, Uppsala University, Sweden
- Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Sweden
- Anne H. Berman, Department of Psychology, Uppsala University, Von Kraemers allé 1A & 1C, 752 37 Uppsala, Sweden. E-mail:
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Olof Molander
- Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Sweden
| | | | - Philip Lindner
- Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Sweden
| | | | - Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Sweden
| | - Karin Engström
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Claes Andersson
- Department of Psychology, Uppsala University, Sweden
- Department of Criminology, Malmö University, Sweden
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24
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Leong R, Lee TSJ, Chen Z, Zhang C, Xu J. Global Temporal Patterns of Age Group and Sex Distributions of COVID-19. Infect Dis Rep 2021; 13:582-596. [PMID: 34205538 PMCID: PMC8293195 DOI: 10.3390/idr13020054] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/20/2022] Open
Abstract
Since the beginning of 2020, COVID-19 has been the biggest public health crisis in the world. To help develop appropriate public health measures and deploy corresponding resources, many governments have been actively tracking COVID-19 in real time within their jurisdictions. However, one of the key unresolved issues is whether COVID-19 was distributed differently among different age groups and between the two sexes in the ongoing pandemic. The objectives of this study were to use publicly available data to investigate the relative distributions of COVID-19 cases, hospitalizations, and deaths among age groups and between the sexes throughout 2020; and to analyze temporal changes in the relative frequencies of COVID-19 for each age group and each sex. Fifteen countries reported age group and/or sex data of patients with COVID-19. Our analyses revealed that different age groups and sexes were distributed differently in COVID-19 cases, hospitalizations, and deaths. However, there were differences among countries in both their age group and sex distributions. Though there was no consistent temporal change across all countries for any age group or either sex in COVID-19 cases, hospitalizations, and deaths, several countries showed statistically significant patterns. We discuss the potential mechanisms for these observations, the limitations of this study, and the implications of our results on the management of this ongoing pandemic.
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Affiliation(s)
- Russell Leong
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (R.L.); (T.-S.J.L.); (Z.C.); (C.Z.)
| | - Tin-Suet Joan Lee
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (R.L.); (T.-S.J.L.); (Z.C.); (C.Z.)
| | - Zejia Chen
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (R.L.); (T.-S.J.L.); (Z.C.); (C.Z.)
| | - Chelsea Zhang
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (R.L.); (T.-S.J.L.); (Z.C.); (C.Z.)
| | - Jianping Xu
- Department of Biology and Institute of Infectious Diseases Research, McMaster University, Hamilton, ON L8S 4K1, Canada
- Correspondence:
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25
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Development of the Adult Pandemic Attitude Scale (A-PAS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126311. [PMID: 34200858 PMCID: PMC8296124 DOI: 10.3390/ijerph18126311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/23/2022]
Abstract
This study aimed to develop an instrument for measuring the attitudes that reflect the characteristics of the pandemic (Adult Pandemic Attitude Scale (A-PAS)) and verifying its validity and reliability. This study used a methodological research design and was conducted with a development step and an evaluation step. The development step included development of preliminary items, content validity, face validity, and preliminary investigation. The evaluation step included item analysis, construct validity, convergent validity, discriminant validity, criterion validity, factor naming, reliability, and completion of the final instrument. The A-PAS developed in this study consisted of a total of 20 items in five dimensions. The internal consistency of 20 items of the A-PAS, Cronbach’s α was 0.92 for 20 items, Cronbach’s α for each factor, a subscale of instrument, was 0.61~0.87 and Raykov’s p coefficient of each factor, which is a subscale of the tool, was found to be 0.60 to 0.88. Analysis of construct validity showed the results as follows: χ2 (p) = 134.05 (p < 0.001), RMSEA = 0.02, RMR = 0.02, GFI = 0.94, CFI = 0.99. The study findings suggest that the developed instrument can be utilized to measure the attitudes of adults toward pandemics, and reflect the reality of the pandemic situation. The outcomes can be used as valuable data for intervention, prevention activities, and policy preparation. The instrument will be applied in the event of a pandemic, such as COVID-19, and will be helpful in promoting the health of the people.
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Basellini U, Alburez-Gutierrez D, Del Fava E, Perrotta D, Bonetti M, Camarda CG, Zagheni E. Linking excess mortality to mobility data during the first wave of COVID-19 in England and Wales. SSM Popul Health 2021; 14:100799. [PMID: 33898726 PMCID: PMC8058100 DOI: 10.1016/j.ssmph.2021.100799] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 02/08/2023] Open
Abstract
Non-pharmaceutical interventions have been implemented worldwide to curb the spread of COVID-19. However, the effectiveness of such governmental measures in reducing the mortality burden remains a key question of scientific interest and public debate. In this study, we leverage digital mobility data to assess the effects of reduced human mobility on excess mortality, focusing on regional data in England and Wales between February and August 2020. We estimate a robust association between mobility reductions and lower excess mortality, after adjusting for time trends and regional differences in a mixed-effects regression framework and considering a five-week lag between the two measures. We predict that, in the absence of mobility reductions, the number of excess deaths could have more than doubled in England and Wales during this period, especially in the London area. The study is one of the first attempts to quantify the effects of mobility reductions on excess mortality during the COVID-19 pandemic.
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Affiliation(s)
- Ugofilippo Basellini
- Max Planck Institute for Demographic Research (MPIDR), Rostock, Germany
- Institut National D’études Démographiques (INED), Aubervilliers, France
| | | | - Emanuele Del Fava
- Max Planck Institute for Demographic Research (MPIDR), Rostock, Germany
| | - Daniela Perrotta
- Max Planck Institute for Demographic Research (MPIDR), Rostock, Germany
| | - Marco Bonetti
- Carlo F. Dondena Centre & Covid Crisis Lab, Bocconi University, Milan, Italy
| | - Carlo G. Camarda
- Institut National D’études Démographiques (INED), Aubervilliers, France
| | - Emilio Zagheni
- Max Planck Institute for Demographic Research (MPIDR), Rostock, Germany
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Olamijuwon EO. Characterizing low effort responding among young African adults recruited via Facebook advertising. PLoS One 2021; 16:e0250303. [PMID: 33989304 PMCID: PMC8121367 DOI: 10.1371/journal.pone.0250303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/05/2021] [Indexed: 11/19/2022] Open
Abstract
Multiple studies have successfully used Facebook's advertising platform to recruit study participants. However, very limited methodological discussion exists regarding the magnitude of low effort responses from participants recruited via Facebook and African samples. This study describes a quasi-random study that identified and enrolled young adults in Kenya, Nigeria, and South Africa between 22 May and 6 June 2020, based on an advertisement budget of 9,000.00 ZAR (US $521.44). The advertisements attracted over 900,000 views, 11,711 unique clicks, 1190 survey responses, and a total of 978 completed responses from young adults in the three countries during the period. Competition rates on key demographic characteristics ranged from 82% among those who attempted the survey to about 94% among eligible participants. The average cost of the advertisements was 7.56 ZAR (US $0.43) per survey participant, 8.68 ZAR (US $0.50) per eligible response, and 9.20 ZAR (US $0.53) per complete response. The passage rate on the attention checks varied from about 50% on the first question to as high as 76% on the third attention check question. About 59% of the sample passed all the attention checks, while 30% passed none of the attention checks. Results from a truncated Poisson regression model suggest that passage of attention checks was significantly associated with demographically relevant characteristics such as age and sex. Overall, the findings contribute to the growing body of literature describing the strengths and limitations of online sample frames, especially in developing countries.
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Affiliation(s)
- Emmanuel Olawale Olamijuwon
- Faculty of Social Science, Department of Statistics and Demography, University of Eswatini, Kwaluseni, Eswatini
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Zhang J, Litvinova M, Liang Y, Zheng W, Shi H, Vespignani A, Viboud C, Ajelli M, Yu H. The impact of relaxing interventions on human contact patterns and SARS-CoV-2 transmission in China. SCIENCE ADVANCES 2021; 7:eabe2584. [PMID: 33962957 PMCID: PMC8104862 DOI: 10.1126/sciadv.abe2584] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/19/2021] [Indexed: 05/22/2023]
Abstract
Nonpharmaceutical interventions to control SARS-CoV-2 spread have been implemented with different intensity, timing, and impact on transmission. As a result, post-lockdown COVID-19 dynamics are heterogeneous and difficult to interpret. We describe a set of contact surveys performed in four Chinese cities (Wuhan, Shanghai, Shenzhen, and Changsha) during the pre-pandemic, lockdown and post-lockdown periods to quantify changes in contact patterns. In the post-lockdown period, the mean number of contacts increased by 5 to 17% as compared to the lockdown period. However, it remains three to seven times lower than its pre-pandemic level sufficient to control SARS-CoV-2 transmission. We find that the impact of school interventions depends nonlinearly on the intensity of other activities. When most community activities are halted, school closure leads to a 77% decrease in the reproduction number; in contrast, when social mixing outside of schools is at pre-pandemic level, school closure leads to a 5% reduction in transmission.
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Affiliation(s)
- Juanjuan Zhang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Maria Litvinova
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
- ISI Foundation, Turin, Italy
| | - Yuxia Liang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Wen Zheng
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Huilin Shi
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Alessandro Vespignani
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA, USA
- ISI Foundation, Turin, Italy
| | - Cecile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Marco Ajelli
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA.
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA, USA
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
- Department of infectious diseases, Huashan Hospital, Fudan University
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University
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Perrotta D, Grow A, Rampazzo F, Cimentada J, Del Fava E, Gil-Clavel S, Zagheni E. Behaviours and attitudes in response to the COVID-19 pandemic: insights from a cross-national Facebook survey. EPJ DATA SCIENCE 2021; 10:17. [PMID: 33880320 PMCID: PMC8050509 DOI: 10.1140/epjds/s13688-021-00270-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/11/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND In the absence of medical treatment and vaccination, individual behaviours are key to curbing the spread of COVID-19. Here we describe efforts to collect attitudinal and behavioural data and disseminate insights to increase situational awareness and inform interventions. METHODS We developed a rapid data collection and monitoring system based on a cross-national online survey, the "COVID-19 Health Behavior Survey". Respondent recruitment occurred via targeted Facebook advertisements in Belgium, France, Germany, Italy, the Netherlands, Spain, the United Kingdom, and the United States. We investigated how the threat perceptions of COVID-19, the confidence in the preparedness of organisations to deal with the pandemic, and the adoption of preventive and social distancing behaviours are associated with respondents' demographic characteristics. RESULTS We analysed 71,612 questionnaires collected between March 13-April 19, 2020. We found substantial spatio-temporal heterogeneity across countries at different stages of the pandemic and with different control strategies in place. Respondents rapidly adopted the use of face masks when they were not yet mandatory. We observed a clear pattern in threat perceptions, sharply increasing from a personal level to national and global levels. Although personal threat perceptions were comparatively low, all respondents significantly increased hand hygiene. We found gender-specific patterns: women showed higher threat perceptions, lower confidence in the healthcare system, and were more likely to adopt preventive behaviours. Finally, we also found that older people perceived higher threat to themselves, while all respondents were strongly concerned about their family. CONCLUSIONS Rapid population surveys conducted via Facebook allow us to monitor behavioural changes, adoption of protective measures, and compliance with recommended practices. As the pandemic progresses and new waves of infections are a threatening reality, timely insights from behavioural and attitudinal data are crucial to guide the decision-making process. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1140/epjds/s13688-021-00270-1.
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Affiliation(s)
- Daniela Perrotta
- Max Planck Institute for Demographic Research, Konrad-Zuse-Straße 1, Rostock, Germany
| | - André Grow
- Max Planck Institute for Demographic Research, Konrad-Zuse-Straße 1, Rostock, Germany
| | - Francesco Rampazzo
- Saïd Business School, Leverhulme Centre for Demographic Science, and Nuffield College, University of Oxford, Park End St., Oxford, United Kingdom
| | - Jorge Cimentada
- Max Planck Institute for Demographic Research, Konrad-Zuse-Straße 1, Rostock, Germany
| | - Emanuele Del Fava
- Max Planck Institute for Demographic Research, Konrad-Zuse-Straße 1, Rostock, Germany
| | - Sofia Gil-Clavel
- Max Planck Institute for Demographic Research, Konrad-Zuse-Straße 1, Rostock, Germany
| | - Emilio Zagheni
- Max Planck Institute for Demographic Research, Konrad-Zuse-Straße 1, Rostock, Germany
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Krauth C, Oedingen C, Bartling T, Dreier M, Spura A, de Bock F, von Rüden U, Betsch C, Korn L, Robra BP. Public Preferences for Exit Strategies From COVID-19 Lockdown in Germany-A Discrete Choice Experiment. Int J Public Health 2021; 66:591027. [PMID: 34744560 PMCID: PMC8565260 DOI: 10.3389/ijph.2021.591027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/22/2021] [Indexed: 01/10/2023] Open
Abstract
Objectives: To decrease the rapid growth of SARS-CoV-2 in Germany, a stepped lockdown was conducted. Acceptance and compliance regarding entering and exiting lockdown measures are key for their success. The aim of the present study was to analyse the population's preferences for exiting lockdown measures. Methods: To evaluate population's preferences and identify trade-offs between different exit strategies, a discrete choice experiment was conducted on 28-29 April (n = 1,020). Overall, six attributes and 16 choice sets (fractional-factorial design) without an opt-out were chosen. Conditional logit and latent class models were conducted. Results: Most attributes proved to be significant. Two attributes dominated all others: Avoiding a mandatory tracing app, and providing sufficient intensive care capacities. Preventing a high long-term unemployment rate and avoiding the isolation of persons aged 70+, were relevant, though utilities were comparatively lower. We identified subgroups (elderly persons and persons with school children) with different utilities, which indicates specific attributes affecting them dissimilarly. Conclusions: The population prefers cautious re-opening strategies and is at least sceptical about the adoption of severe protection measures. Government should balance interests between subgroups.
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Affiliation(s)
- Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
- Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - Carina Oedingen
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
- Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - Tim Bartling
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
- Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Anke Spura
- Federal Centre for Health Education (BZgA), Cologne, Germany
| | - Freia de Bock
- Federal Centre for Health Education (BZgA), Cologne, Germany
| | | | - Cornelia Betsch
- Heisenberg-Professorship of Health Communication, University of Erfurt, Erfurt, Germany
| | - Lars Korn
- Heisenberg-Professorship of Health Communication, University of Erfurt, Erfurt, Germany
| | - Bernt-Peter Robra
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University of Magdeburg, Magdeburg, Germany
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