Public perceptions of non-adherence to pandemic protection measures by self and others: A study of COVID-19 in the United Kingdom

Addressing Vaccine Hesitancy in College Students Post COVID-19 Pandemic: A Systematic Review Using COVID-19 as a Case Study

Background: Resistance to vaccinations continues to pose a considerable challenge to attaining widespread vaccination, especially among the college student demographic, who are pivotal in championing public health initiatives. This systematic review investigates the elements that influence reluctance to receive the COVID-19 vaccine among university students globally. Utilizing the WHO's 3C model, which encompasses confidence, complacency, and convenience, this review seeks to pinpoint the main factors and suggest focused strategies to address them. Methods: Following the PRISMA guidelines, we conducted a systematic search in PubMed, Medline, Web of Science, Scopus, Embase, and Global Health. Eligible studies were cross-sectional, peer-reviewed, and examined COVID-19 vaccine hesitancy among college students. Covidence was used for screening, and data were synthesized narratively using the 3C model. Results: Sixty-seven studies (n = 88,345 participants) from 25 countries were included in this study. Confidence factors were the most influential, with fear of side effects (87.18%) and doubts about efficacy (72.4%) as primary concerns. Complacency factors included a low perceived risk of infection (34.9%) and a preference for alternative preventive measures (52.3%). Convenience barriers involved financial costs (58.1%) and difficulty accessing vaccination centers (40.3%). Subgroup analyses revealed variations by academic discipline and geographic region, with medical students showing hesitancy despite their health knowledge. Conclusions: COVID-19 vaccine hesitancy among college students is primarily driven by safety concerns, misinformation, and accessibility barriers. Addressing hesitancy requires transparent risk communication, policy-driven accessibility improvements, and tailored educational interventions. These findings can inform strategies to enhance vaccine uptake among young adults and contribute to broader efforts in pandemic preparedness.

Measuring associations among British national identification, group norms and social distancing behaviour during the COVID-19 pandemic: Testing a Social Identity Model of Behavioural Associations (SIMBA)

Social identification and group norms have been identified as key social psychological determinants of engagement in protective public health behaviours, such as social distancing, in the context of the COVID-19 pandemic. Drawing upon both social identity and balanced identity theories, the research tests the utility of a Social Identity Model of Behavioural Associations (SIMBA)-which proposes reciprocal, interactive associations among self-group, group-behaviour and self-behaviour concepts-for the measurement of British national identification, group norms and social distancing behaviour at two different points during the pandemic. An online study asked participants (Time 1 N = 151, Time 2 N = 136) to complete implicit and explicit (i.e. self-report) measures both during and post-lockdown. Results demonstrated associations to be relatively stable across time and found strong correlational confirmation that the strength of any one association in the SIMBA could be predicted by the interactive strength of the remaining two-both implicitly and explicitly. However, the strength of any one association, as measured post-lockdown, was not predicted by the interaction between the change scores of the remaining two-suggesting that the constructs may not be long-range predictors of one another. Findings are discussed in terms of the value of the SIMBA for the measurement and modification of novel, emergent group-based associations.

Socioeconomic status and adherence to COVID-19 preventative measures in Australia: A national cohort study

ISSUE ADDRESSED

The uptake of recommended preventative measures is a critical concern for protecting the public against COVID-19 outbreaks and future pandemics. However, it is unclear to what extent COVID-19 preventative measures were followed in Australia. This study aims to determine adherence level to COVID-19 preventative measures in 2021, and whether these were associated with socioeconomic status (SES).

STUDY DESIGN

This was a national cross-sectional study using data from the Household Income and Labour Dynamics in Australia (HILDA) survey.

METHODS

This study included 15 457 community-dwelling adults (18 years or older) who participated in the 2021 wave of HILDA survey. SES was assessed by the Socio-Economic Index For Areas (SEIFA) score, split into quintiles. Outcomes included self-reported adherence to COVID-19 preventative measures (mask wearing, keeping distance, staying home; sum score range 3-15) and COVID-19 status (yes/no). Linear and logistic regression were used accordingly to assess the association between SES and the sum score of adherence to COVID-19 measures, and COVID-19 vaccination status.

RESULTS

Adherence to COVID-19 preventative measures and uptake of COVID-19 vaccine in Australia in 2021 were moderate (between 60% and 70%). Regression models showed higher SES was associated with a slightly higher score of adherence (β = .08, 95% CI = .04-.12) and a higher likelihood of self-reporting receiving COVID-19 vaccination (OR 1.27, 95% CI = 1.23-1.31).

CONCLUSION

SES was positively associated with the level of adherence to COVID-19 preventative measures and the probability of receiving COVID-19 vaccine. The findings of this study highlight the potential benefits of considering SES, particularly its impact on equity and access, when designing an educational program or awareness campaign in times of crisis. SO WHAT?: The findings of this study highlight the importance of considering SES when designing an educational program or an awareness campaign in times of crisis.

The protective power of dissent? A longitudinal study on cognitive and socio-emotional determinants of COVID-19 vaccine hesitancy among young people in Canada

COVID-19 has elicited polarized reactions to public health measures, fueling anti-vaccination movements worldwide which indicate that vaccine hesitancy represents a common expression of dissent. We investigate changes in cognitive (i.e., trust in government, conspiracy beliefs, vaccine attitudes, and other COVID-19-related factors) and socio-emotional factors (i.e., psychological distress and social support) over time, and examine if these factors are associated with COVID-19 vaccine hesitancy. A sample of Canadian young adults (N = 2,695; 18 to 40 years old) responded to an online survey in May/June 2021 (after the first vaccination campaign) and then in November 2021 (after vaccine mandates were introduced). Based on survey answers, participants were categorized as "not hesitant", "hesitant", and "do not intend to get vaccinated" at each time point. Results from generalized estimating equation models indicate that vaccination hesitancy decreased over time. The importance attributed to specific COVID-19-related factors (e.g., research and science about COVID-19 vaccines, opinions of friends and family) decreased whereas psychological distress increased over time. Cognitive and socio-emotional factors were associated with vaccine hesitancy, with participants who did not intend to get vaccinated reporting the lowest psychological distress scores. We argue that dissent may be an empowering way for young people to restore a sense of personal agency via the opposition to a system perceived as illegitimate and/or unfair. These results raise important questions about potential collateral effects of top-down government and public health interventions in times of crisis.

Compliance with COVID-19 government guidance and rules by disabled people and people from minoritised ethnic groups: Qualitative findings from the CICADA study

Within the 2020/21 CICADA (Coronavirus Intersectionalities: Chronic Conditions or Disabilities and Migrants and other Ethnic minorities) study, we explored full, partial or noncompliance with government COVID-19 infection-containment measures by people from minoritised ethnic groups with a disabling health condition or impairment. We used an assets-based intersectional approach and purposive sampling, included non-disabled and White British comparators, and trained community co-researchers to help us reach undocumented migrants and asylum seekers. We undertook 271 semi-structured qualitative interviews, followed by participatory workshops with interviewees to explore data and changes in experiences five and 10 months after the interviews. Perceiving their vulnerability to COVID-19, most participants quickly and often zealously adopted infection-containment behaviours, and continued this after restrictions were lifted. This could reduce mental wellbeing, especially in community-facing cultures, and could create family conflict. Various structural inequities impeded compliance. Many, especially undocumented migrants, felt imprisoned. The intersection of gender, citizenship, socioeconomic status and culture impacted disclosures of COVID-19 infection, support seeking and use. Many were unclear what was safe as well as unsafe. People complained that disability and cultural considerations were omitted from policymaking. Participants mostly had taken the COVID-19 vaccine by October 2022, but ethnic minority participants needed time to deliberate and trusted, community-embedded information whereas White British participants were mostly influenced by mass media. The intersection of health condition or impairment, poverty, and living alone led to more non-compliance with general rules, and more vaccine hesitancy than did misinformation spread through ethnic community channels. Many participants were reluctant to reintegrate in May 2022 because of continued perceived vulnerability to COVID-19 but by September 2022 = seemed more concerned about the economic crisis. We add two new 'types' to existing compliance typologies: deliberators (who eventually decide to follow the rules), and 'necessity-driven non-compliers' who are totally unable to comply because of their disabilities.

Contributions of the qualitative Qualicor study embedded in a cohort study on the circumstances of SARS-CoV 2 infection in France

OBJECTIVES

This study aims to understand a major result of ComCor, an online epidemiological study conducted to identify the circumstances of COVID-19 infection in France from 2020 to 2022: One third of respondents reported ignoring the circumstances of their infection.

METHODS

We conducted a qualitative study through semi-structured interviews, diagnosed in spring or summer 2021. Interviews were audio recorded, transcribed, and thematically analyzed.

RESULTS

Fifty interviews were conducted. Half of the participants in Qualicor were able to identify several at-risk situations, most often involving their entourage (family, friends, colleagues), but were uncertain as to which specific situation was the source of infection. Less than one quarter strongly suspected a specific situation without certainty, a similar proportion were unable to identify any circumstances, and only two people were certain about the origin of the infection. Several factors contributed to this lack of knowledge: a desire to conceal these circumstances (in a few rare cases), limitations of the questionnaire, lack of knowledge about how the virus is transmitted, selective perception of at-risk situations, co-existence of several possible sources of infection, and the difficulty of taking an objective view of certain circumstances of transmission.

CONCLUSION

Our study shows the benefits of a mixed approach designed to better understand the perception of Covid 19 contamination circumstances in the French population. It also highlights the need to strengthen or improve communication on modes of virus transmission, especially airborne transmission, and the importance of maintaining certain preventive behaviors after vaccination.

Oscillating autonomy: a grounded theory study of women's experiences of COVID-19 infection during pregnancy, labour and birth, and the early postnatal period

BACKGROUND

Testing positive for COVID-19 was associated with higher rates of detrimental psycho-social and physical health outcomes. The COVID-19 pandemic caused unprecedented disruption to everyday life. This included major reconfiguration of maternal, child, and perinatal mental health and care services and provision. This study aimed to investigate the experiences of those who tested positive for COVID-19 during pregnancy, labour and birth, or the early postnatal period.

METHODS

National on-line recruitment from across the United Kingdom resulted in sixteen mothers being invited to qualitative semi-structured interviews to understand the experiences of mothers who had been infected by COVID-19 during pregnancy, labour and birth, or the early postnatal period. Interviews were conducted, recorded, and transcribed using video-conferencing software. A Grounded Theory approach was used to analyse the data gathered pertaining to women's experiences of their positive COVID-19 diagnosis during pregnancy, labour and birth, or the early postnatal period.

RESULTS

The theory of 'Oscillating Autonomy - Losing and Seeking to Regain Control by Striving for Agency' was developed, comprising three main themes: 'Anxious Anticipation: The fear of infection was worse than COVID-19 itself'; 'Fluctuating Agency: What changed when COVID-19 took control'; and 'Reclaiming Control: Seeking reassurance during COVID-19 positivity'. Testing positive for COVID-19 whilst pregnant, during labour or birth, or in the early postnatal period was associated with a perceived loss of control. Those who were able to regain that control felt more secure in their situation.

CONCLUSIONS

Support was paramount to manage increased vulnerability, as was reassurance achieved by information seeking and positive action including increased health monitoring and COVID-19 vaccination.

Self-directed learning among general practitioners in the German-speaking part of Switzerland: a qualitative study using semi-structured interviews

AIMS OF THE STUDY

This research aimed to investigate the self-directed learning (SDL) habits of Swiss general practitioners from the German-speaking part of Switzerland, understanding how they acquire new knowledge, exploring the impact of the COVID-19 pandemic on these habits and identifying optimisation strategies for their future self-directed learning.

METHODS

We employed a qualitative study design, conducting semi-structured interviews with 16 general practitioners from 30 May 2022 to 06 July 2022. Thematic analysis based on a mixed deductive/inductive approach was used to gain insight into the learning activities and self-directed learning practices of the practitioners.

RESULTS

The interviewed general practitioners demonstrated a versatile approach to self-directed learning, where peer communication emerged as the most predominant learning method. It is noteworthy that the younger generation in particular showed a strong inclination for peer learning and is well prepared for the integration of advanced digital solutions for peer communication. Furthermore, a significant shift was observed in media-based self-directed learning, especially since the COVID-19 pandemic. Digital platforms and repositories for practical learning were mentioned as educational mainstays by many interviewees, reflecting a profound technological shift observed over the past 25 years and especially since the pandemic. The primary motivation for pursuing new knowledge remains patient care, although personal development and staying up-to-date with medical and technological advancements are also key motivators. Although the pandemic has undeniably accelerated the transition towards digital learning, it has also brought with it challenges such as information overload and technical difficulties. There was an evident decline in formal learning venues and physical presence during the pandemic, yet the reported value of in-person interactions remains high. Suggestions for optimising self-directed learning included enhancing digital offerings, fostering stronger peer networks and integrating more practical content.

CONCLUSIONS

The COVID-19 pandemic has catalysed a transformation in the self-directed learning practices of general practitioners in the German-speaking part of Switzerland, underlining the importance of a balanced approach between digital and traditional learning methods. As the digital realm of self-directed learning grows, it is essential to address existing challenges and capitalise on potential advantages. Both individual networking efforts like general practitioner quality circles and initiatives from official authorities like informal self-test opportunities can play pivotal roles in refining self-directed learning practices. The findings from this study offer valuable insights for enhancing learning resources and environments that align with general practitioners' needs and preferences. Future research should investigate the ongoing impact of advanced digital technologies on self-directed learning to understand the evolving landscape in a post-pandemic world.

Understanding factors for adhering to health recommendations during COVID-19 among older adults - a qualitative interview study using health belief model as analytical framework

INTRODUCTION

The COVID-19 pandemic has presented a unique possibility to broaden the understanding of people's reactions to a global crisis. Early on, it became evident that older adults were particularly vulnerable to the virus and that the actions of this age group would be crucial to the outcome. This qualitative interview study uses the Health Belief Model (HBM) framework as an analytical tool to examine older people's experiences of adherence to recommendations during the initial phase of the COVID-19 pandemic. It is important to view this study in the context of Sweden's voluntary restrictions, which further highlight the unique nature of this research.

METHOD

In April-May 2020, 41 adults aged 70-85 participated in unstructured phone interviews. The objective was to investigate older adults' perceptions of the COVID-19 pandemic, particularly their understanding of the disease and the conditions that influenced their adherence to health recommendations. HBM was used as an analytical framework to guide the analysis of the interviews.

RESULTS

Despite perceiving COVID-19 as a severe threat to health and society, participants did not let fear dominate their responses. Instead, they demonstrated remarkable resilience and a proactive approach. For some, the perceived susceptibility to the disease was the primary motivator for adherence to the Swedish national recommendations. Notably, trust in the authorities and family members' requests significantly bolstered adherence. Moreover, adherence was found to contribute to feelings of safety. Conversely, potential barriers to adhering to recommendations included missing loved ones and frustration with sometimes ambiguous information from authorities.

CONCLUSIONS

The results from this study indicate that older adults are willing to adhere to voluntary restrictions during a global pandemic. Relatives of older people are a resource for communicating information regarding safety and health messages, a message that is preferably thorough and consistent. Further, much can be gained if loneliness during isolation can be mitigated since missing loved ones appears to be a potential barrier to adherence.

The Experiences of Autistic People When Facemask Wearing and Interacting with Masked Individuals

Background

The World Health Organization recommended that individuals use a facemask to prevent the ongoing spread of COVID-19. Many governments implemented this recommendation into law. However, the increased usage of facemasks may have had particular impacts on the autistic population, due to differences in emotion processing, sensory issues, and anxiety about regularly changing rules. This research aimed to investigate the lived experiences of autistic people when wearing facemasks and their experiences interacting with others wearing facemasks.

Methods

First, the research team conducted a content analysis of social media posts (n = 124) created by autistic individuals. Based on this, we developed a novel questionnaire and distributed it so that autistic adults could share their facemask experiences (n = 49).

Results

Seven main themes were identified from the social media analyses: general attitudes toward masks, sensory issues, "wear-a-mask" message, rules and expectations, sunflower lanyards, social problems and benefits, and mask exemption. Secondary questionnaire responses highlighted that the experience of facemasks was mixed. Many individuals experienced sensory issues. Yet, for some individuals, there were benefits: they did not have to monitor their facial expressions to camouflage their autistic responses. Participants reported differing opinions on the topic of mask exemption, and the sunflower lanyard as a symbol of mask exemption. Data did not suggest anxiety around rule changes but did suggest feelings of anger at others who were perceived not to be following the rules.

Conclusions

These findings highlight the mixed experiences of autistic people with facemasks and suggest lessons for future events in which there are rapid changes to public health messaging.

Autonomous and policy-induced behavior change during the COVID-19 pandemic: Towards understanding and modeling the interplay of behavioral adaptation

Changes in human behaviors, such as reductions of physical contacts and the adoption of preventive measures, impact the transmission of infectious diseases considerably. Behavioral adaptations may be the result of individuals aiming to protect themselves or mere responses to public containment measures, or a combination of both. What drives autonomous and policy-induced adaptation, how they are related and change over time is insufficiently understood. Here, we develop a framework for more precise analysis of behavioral adaptation, focusing on confluence, interactions and time variance of autonomous and policy-induced adaptation. We carry out an empirical analysis of Germany during the fall of 2020 and beyond. Subsequently, we discuss how behavioral adaptation processes can be better represented in behavioral-epidemiological models. We find that our framework is useful to understand the interplay of autonomous and policy-induced adaptation as a "moving target". Our empirical analysis suggests that mobility patterns in Germany changed significantly due to both autonomous and policy-induced adaption, with potentially weaker effects over time due to decreasing risk signals, diminishing risk perceptions and an erosion of trust in the government. We find that while a number of simulation and prediction models have made great efforts to represent behavioral adaptation, the interplay of autonomous and policy-induced adaption needs to be better understood to construct convincing counterfactual scenarios for policy analysis. The insights presented here are of interest to modelers and policy makers aiming to understand and account for behaviors during a pandemic response more accurately.

Assessing SARS-CoV-2 Testing Adherence in a University Town: Recurrent Event Modeling Analysis

BACKGROUND

Healthy Davis Together was a program launched in September 2020 in the city of Davis, California, to mitigate the spread of COVID-19 and facilitate the return to normalcy. The program involved multiple interventions, including free saliva-based asymptomatic testing, targeted communication campaigns, education efforts, and distribution of personal protective equipment, community partnerships, and investments in the local economy.

OBJECTIVE

This study identified demographic characteristics of individuals that underwent testing and assessed adherence to testing over time in a community pandemic-response program launched in a college town in California, United States.

METHODS

This study outlines overall testing engagement, identifies demographic characteristics of participants, and evaluates testing participation changes over 4 periods of the COVID-19 pandemic, distinguished by the dominant variants Delta and Omicron. Additionally, a recurrent model is employed to explore testing patterns based on the participants' frequency, timing, and demographic characteristics.

RESULTS

A total of 770,165 tests were performed between November 18, 2020, and June 30, 2022, among 89,924 (41.1% of total population) residents of Yolo County, with significant participation from racially or ethnically diverse participants and across age groups. Most positive cases (6351 of total) and highest daily participation (895 per 100,000 population) were during the Omicron period. There were some gender and age-related differences in the pattern of recurrent COVID-19 testing. Men were slightly less likely (hazard ratio [HR] 0.969, 95% CI 0.943-0.996) to be retested and more likely (HR 1.104, 95% CI 1.075-1.134) to stop testing altogether than women. People aged between 20 and 34 years were less likely to be retested (HR 0.861, 95% CI 0.828-0.895) and more likely to stop testing altogether (HR 2.617, 95% CI 2.538-2.699). However, older age groups were less likely to stop testing, especially those aged between 65-74 years and 75-84 years, than those aged between 0 and 19 years. The likelihood of stopping testing was lower (HR 0.93, 95% CI 0.889-0.976) for the Asian group and higher for the Hispanic or Latino (HR 1.185, 95% CI 1.148-1.223) and Black or African American (HR 1.198, 95% CI 1.054-1.350) groups than the White group.

CONCLUSIONS

The unique features of a pandemic response program that supported community-wide access to free asymptomatic testing provide a unique opportunity to evaluate adherence to testing recommendations and testing trends over time. Identification of individual and group-level factors associated with testing behaviors can provide insights for identifying potential areas of improvement in future testing initiatives.

Unraveling the effects of the Ebola experience on behavior choices during COVID-19 in Liberia: a mixed-methods study across successive outbreaks

BACKGROUND

The burden of the COVID-19 pandemic in terms of morbidity and mortality differentially affected populations. Between and within populations, behavior change was likewise heterogeneous. Factors influencing precautionary behavior adoption during COVID-19 have been associated with multidimensional aspects of risk perception; however, the influence of lived experiences during other recent outbreaks on behavior change during COVID-19 has been less studied.

METHODS

To consider how the direct disease experience ("near misses") and behavior change during the 2014-2016 Ebola virus disease (EVD) outbreak may have impacted behavior change during the early waves of the COVID-19 outbreak in West Africa, we analyzed data from a mixed-methods study that included a phone-based survey and in-depth interviews among vaccinated Liberian adults. Logistic regression via generalized estimating equations with quasi-likelihood information criterion (QIC)-based model selection was conducted to evaluate the influence of the interaction between and individual effects of the outbreak (EVD and COVID-19) and the "near-miss" experience on adoption of individual precautionary behaviors. Thematic analysis of interview transcripts explored reasons for differential behavior adoption between the two outbreaks.

RESULTS

At the population level, being a "near miss" was not associated with significantly different behavior during COVID-19 versus Ebola; however, overall, people had lower odds of adopting precautionary behaviors during COVID-19 relative to during Ebola. Participants who report near miss experiences during Ebola were significantly more likely to report having a household member test positive for COVID-19 (p<0.001). Qualitatively, participants often reflected on themes around more proximal and personal experiences with Ebola than with COVID-19; they also commented on how EVD led to better preparedness at the systems level and within communities for how to behave during an outbreak, despite such awareness not necessarily translating into action during COVID-19.

CONCLUSIONS

The results suggest that perceived proximity and intensity to disease threats in space and time affect behavioral decisions. For successive disease threats, comparisons of the present outbreak to past outbreaks compound those effects, regardless of whether individuals were directly impacted via a "near-miss" experience. Measures, such as risk communication and community engagement efforts, that gauge and reflect comparisons with previous outbreaks should be considered in response strategies to enhance the adoption of precautionary behavior.

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

Background

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

Methods

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

Results

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

Conclusion

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

The paradox of pandemic mitigation? Moderating role of pandemic severity on the impact of social distancing policies: a cultural value perspective

BACKGROUND

Social distancing policies were of utmost importance during the early stages of the COVID-19 pandemic. These policies aimed to mitigate the severity of local outbreaks by altering public behavior. However, if the severity of the pandemic reduces, the impact of these policies on actual behavior may decrease. This study aims to examine, from a global perspective, whether the impact of social distancing policies on actual mobility is moderated by local pandemic severity and whether this moderating effect varies across cultural value contexts.

METHODS

We combined multiple publicly available global datasets for structural equation model analysis. 17,513 rows of data from 57 countries included in all databases were analyzed. Multilevel moderated moderation models were constructed to test the hypotheses.

RESULTS

More stringent policies in a region mean less regional mobility (β = -0.572, p < 0.001). However, the severity of local outbreaks negatively moderated this effect (β = -0.114, p < 0.001). When the pandemic was not severe, the influence of policy intensity on mobility weakened. Furthermore, based on Schwartz's cultural values theory, cultural values of autonomy (β = -0.109, p = 0.011), and egalitarianism (β = -0.108, p = 0.019) reinforced the moderating effect of pandemic severity. On the other hand, cultural values of embeddedness (β = 0.119, p = 0.006) and hierarchy (β = 0.096, p = 0.029) attenuated the moderating effect.

CONCLUSIONS

Social distancing policies aim to reduce the severity of local pandemics; however, the findings reveal that mitigating local pandemics may reduce their impact. Future policymakers should be alert to this phenomenon and introduce appropriate incentives to respond. The results also show that the moderating role of pandemic severity varies across cultures. When policies are promoted to deal with global crises, policymakers must seriously consider the resistance and potential incentives of cultural values.

Crossroads of well-being and compliance: a qualitative cohort study of visitor restriction policy during the COVID-19 pandemic, the Netherlands, May 2020-December 2021

BACKGROUND

In this qualitative study we observed in-depth the impact of the visiting restriction policy (VRP, i.e. number of visitors allowed at home) on well-being and compliance during the COVID-19 pandemic to regulate infection rates.

METHODS

A cohort of 15 interviewees was followed throughout the COVID-19 pandemic in the Netherlands in 12 interview rounds (May 2020-December 2021). Every round semi-structured telephone interviews were conducted by a team of 8 researchers. In total 176 interviews were conducted.

RESULTS

This study showed that four categories can be identified when observing the impact of the VRP on well-being and compliance. For Resilient-Followers reasons for compliance were risk perception, following government rules, and for some having a small social circle. Because they accepted the situation, well-being was hardly affected. Resilient-Rulebreakers made their own risk assessment of people they met. Their well-being was hardly affected, because they experienced social rest and interpreted the measure in their own way. Suffering-Followers complied, because of risk perception, following government rules, and working in healthcare. However, the VRP had substantial impact on well-being, because social structures were disrupted. Suffering-Rulebreakers gave their own interpretation to the VRP, trying to find a balance between compliance and well-being. We observed that the categories were quite stable over time.

CONCLUSIONS

The VRP appeared to be a measure with substantial impact on well-being for some, mostly because social structures were disrupted. The measure showed fluctuating compliance, in which feasibility and frequent changes in the VRP played a role. Well-being seemed related to the number of visitors that was allowed; a restriction of four visitors was feasible, while one visitor resulted in a negative breaking-point in resilience, which had an impact on compliance, even among the most compliant. Taken together, this study provides valuable insights into the implications of and compliance to a VRP during different phases of the COVID-19 pandemic, which may contribute to policymaking during future pandemics.

Public trust in the Government to control the spread of COVID-19 in England after the first wave-a longitudinal analysis

BACKGROUND

To control the spread of coronavirus disease 2019 (COVID-19), governments are increasingly relying on the public to voluntarily manage risk. Effectiveness is likely to rely in part on how much the public trusts the Government's response. We examined the English public's trust in the Conservative Government to control the spread of COVID-19 after the initial 'crisis' period.

METHODS

We analyzed eight rounds of a longitudinal survey of 1899 smartphone users aged 18-79 in England between October 2020 and December 2021. We fitted a random-effects logit model to identify personal characteristics and opinions associated with trust in the Conservative Government to control the spread of COVID-19.

RESULTS

Trust was lowest in January 2021 (28%) and highest in March 2021 (44%). Being older, having lower educational attainment and aligning with the Conservative Party were predictors of higher levels of trust. Conversely, being less deprived, reporting that Government communications were not clear and considering that the measures taken by the Government went too far or not far enough were predictors of being less likely to report a great deal or a fair amount of trust in the Government to control the pandemic.

CONCLUSION

Trust in the Government's response was found to be low throughout the study. Our findings suggest that there may be scope to avoid losing trust by aligning Government actions more closely with scientific advice and public opinion, and through clearer public health messaging. However, it remains unclear whether and how higher trust in the Government's response would increase compliance with Government advice.

Experience Pandemic Fatigue? Social Media Use May Play a Role: Testing a Model of Pandemic Fatigue Development from a Social Media Perspective

Recently, the World Health Organization noted the increasing signs of pandemic fatigue around the world and repeatedly warned the public to continue to stay cautious. The current study explores whether social media use plays a role in the formation and development of pandemic fatigue. Drawing on a survey of 849 social media users in China, the findings indicated that different social media behaviors play different roles in affecting pandemic fatigue. Specifically, social interaction use is negatively associated with pandemic fatigue, mediated by more social support and reduced hopelessness. Active content use contributes to pandemic fatigue development, an association explained by information overload and desensitization. Notably, passive content use is found to trigger reactance but is negatively associated with pandemic fatigue, which is fully mediated by reduced information overload. This study seeks to understand how pandemic fatigue is associated with social media use and to explicate the underlying mechanism. The implications of the findings and directions for future research are discussed.

Lessons identified for a future pandemic

Pandemics are complex events requiring a coordinated, global response. The response to the pandemic exposed vulnerabilities in system preparedness. Lessons arising from the COVID-19 pandemic are characterized by four broad themes: (i) investment in public health and health infrastructure, (ii) countermeasures (medical and non-medical), (iii) risk communication and public health measures and (iv) investment in people and partnerships. Learning from the COVID-19 pandemic identifies an approach that focusses on capacities and capabilities that are pathogen agnostic, ensuring that we can respond to diverse emerging infectious disease threats will be essential. The lessons learned from previous and ongoing infectious disease outbreaks should be kept under constant review, in line with technological and scientific advances, to improve our ability to detect, mitigate and respond to new and emerging threats.

Effectiveness of communications in enhancing adherence to public health behavioural interventions: a COVID-19 evidence review

Health communication has relevance for virtually every aspect of health and well-being, including disease prevention. This review explored the effectiveness of communications in enhancing the adoption of or adherence to behavioural interventions (non-pharmaceutical interventions (NPIs)) related to COVID-19. The review takes the UK as a case study and focuses on self-reported behaviours (e.g. social distancing). It also reviews the psychosocial determinants of adherence. Searches were conducted using PubMed, Scopus, CINAL, ASSIA and iCite databases. Eleven thousand five hundred records were identified and 13 were included in the final sample. Included studies suggest that NPI adoption or adherence was generally high, and communication had significant impacts, with key themes including clarity and consistency, trust and control. Based on the evidence in this review, features of effective communication in the context of NPI adoption or adherence are (i) information should be conveyed clearly and conflicting (mixed) messages should be avoided; (ii) information should be conveyed by trusted sources (e.g. health authorities) and (iii) communication should strike a balance between being authoritative but avoiding language seen as controlling (e.g. 'you must'). Future research should prioritize quantitative, experimental and longitudinal study designs, that focus specifically on communication as an intervention, and which measure behaviour. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.

Association Between Pandemic Fatigue and Disease Knowledge, Attitudes, Concerns, and Vaccination Intention at Two Key Moments of the COVID-19 Pandemic

Objective: This study aimed to describe the change in knowledge, attitudes, concerns, perceptions, preventive practices, and vaccination intention at two key time points of the COVID-19 pandemic and to assess whether these changes varied by level of pandemic fatigue. Methods: Data included in this study came from the third and the ninth round of the COSMO-Spain cross-sectional study. A general linear model was used to investigate the interaction terms between rounds and levels of pandemic fatigue. Results: Changes between rounds were observed in knowledge, attitudes, concerns, perceptions, behaviours, and vaccination intention. Significant interactions between rounds indicated that those with low levels of pandemic fatigue had a greater increase in knowledge, lower decrease in concerns, greater decrease in agreement with the decisions made, and lower increase in vaccination intention compared with those with high pandemic fatigue. Conclusion: As a pandemic evolves, it becomes necessary to consider the level of pandemic fatigue of the population and how this affects knowledge, concerns, and agreement with the measures adopted, as they influence the population's adherence to public health recommendations aimed at controlling infections and protecting the most vulnerable.

Self-compassion buffers the impact of learned helplessness on adverse mental health during COVID-19 lockdown

BACKGROUND

Learned helplessness may be the underlying cause of poor mental health status among college students during the COVID-19 lockdown, and self-compassion as a positive psychological quality may influence the link between learned helplessness and mental health.

METHODS

A sample of 869 Chinese college students (443 male and 426 female), with a mean age of 20.03 (SD = 1.68), completed the Learned Helplessness Scale (LHS), Self-Compassion Scale (SCS), and DASS-21. The moderating effect of self-compassion on the relationship between learned helplessness and anxiety, depression, and stress were calculated.

RESULTS

The interaction term between learned helplessness and self-compassion has a significant coefficient on anxiety, depression, and stress, pointing out self-compassion as a moderator of the association between learned helplessness and adverse mental health.

LIMITATIONS

In the absence of longitudinal data or experimental manipulations, cross-sectional methods cannot verify causal conclusions among the study variables. The analysing results are based only on self-reported data.

DISCUSSION

The present study contributes to a deeper understanding of how learned helplessness and self-compassion during COVID-19 contribute to adverse mental health. The findings suggest that adverse mental health during lockdown is significantly associated with learned helplessness and that self-compassion can buffer this effect, contributing to future psychotherapy and clinical research. Future studies should examine the relationship through a longitudinal design to sort out whether self-compassion is a protective factor against learned helplessness or a moderator of the effects of learned helplessness on mental health.

'All together now': Facilitators and barriers to engagement in mutual aid during the first UK COVID-19 lockdown

Despite undeniable hardship, the onset of the COVID-19 pandemic also saw an outpour of community solidarity and mutual aid towards those in need. This study explored why people participated in mutual aid during the pandemic as well as the factors that contributed to continued involvement and/or its decline. We conducted remote interviews with 17 people in South-east England who had been involved in volunteering and local community mutual aid support groups during the first UK lockdown from March to May 2020. Using thematic analysis, we identified two themes: 1) The emergence of social groups and their psychosocial effects, and 2) Enduring connections and barriers to continued participation. Participants often reported an emergent shared identity, preferring the localised nature of these groups and the associated mutual nature of support. They also reported intentions to continue providing such support, should the need arise again, and any barriers to continued involvement in mutual aid were better explained by structural and systemic issues, rather than individual motivational factors.

The perception of risk in contracting and spreading COVID-19 amongst individuals, households and vulnerable groups in England: a longitudinal qualitative study

BACKGROUND

Social distancing restrictions to manage the COVID-19 pandemic were put in place from March 2020 in the United Kingdom (UK), with those classed as "highly clinically vulnerable" advised to shield entirely and remain at home. However, personal risk perception has been shown to comprise of various elements beyond those outlined in the national pandemic guidance. It is unclear whether those deemed COVID-19 vulnerable identified as high-risk to COVID-19 and thus complied with the relevant advice. The aim of this research is to explore the perception of risk in catching and spreading COVID-19, amongst individuals from individual households, and vulnerable groups in a region of the UK.

METHODS

Two individual, semi-structured interviews were conducted, four-weeks apart, with adults living in households in the Liverpool City Region. At the follow-up interview, participants were given the option of using photo-elicitation to guide the discussion. Reflexive thematic analysis was employed to conceptualise themes. The qualitative analysis was underpinned with symbolic interactionism.

RESULTS

Twenty-seven participants (13:14 males:females, and 20 with a vulnerable risk factor to COVID-19) completed a baseline interview, and 15 of these completed a follow-up interview four-weeks later. Following thematic analysis, two overarching themes were conceptualised, with subthemes discussed: theme 1) Confusion and trust in the risk prevention guidance; and theme 2) Navigating risk: compliance and non-compliance with public health guidance.

CONCLUSION

Participants developed their own understanding of COVID-19 risk perception through personal experience and comparison with others around them, irrespective of vulnerability status. COVID-19 guidance was not complied with as intended by the government, and at times even rejected due to lack of trust. The format in which future pandemic guidance is conveyed must be carefully considered, and take into account individuals' experiences that may lead to non-compliance. The findings from our study can inform future public health policy and interventions for COVID-19 and future pandemics.

Perceived barriers and facilitators for adhering to COVID-19 preventive measures in Chile: a qualitative study in three large cities

BACKGROUND

Globally, it has been reported that different social determinants of health -structural, sociodemographic, economic, living conditions and cultural factors- may affect opportunities to adhere to prevention measures against SARS-CoV-2. The objective of this study was to explore the perceptions around barriers and facilitators for adherence to COVID-19 prevention measures among the adult population residing in three large cities in Chile from a social determinants of health perspective.

METHODS

Qualitative paradigm, multiple case-study design. Online semi-structured interviews were conducted with men and women aged 18 and over from different socioeconomic groups residing in three large cities. For participant recruitment and selection, purposive contacts were made based on community and social media networks, followed by snowball sampling. Saturation was reached at 61 participants, after which a thematic analysis was carried out with the support of AtlasTi software. The Ethics Committee of the Universidad del Desarrollo in Chile approved this study.

RESULTS

The main perceived barriers to adherence to COVID-19 preventive measures are linked to structural social determinants of health such as income, occupation, gender, access to basic supplies, and housing. Perceived facilitators are the fear of contagion and the incorporation of measures into daily habits. The social communication of preventive measures by health authorities is perceived as punitive, affecting adherence once the fear of contagion decreased in the country. It is also perceived that the recommended preventive measures are disconnected from communities' cultural practices and people´s identity, as well as affected by gender inequities and socioeconomic conditions that stakeholders in the country do not sufficiently address.

CONCLUSION

Study findings suggest that adherence to preventive measures, such as social distancing, mask use, and hand washing, could be promoted through their incorporation into the daily life habits of people and communities. These measures should consider the structural social determinants that generate multiple barriers to adherence, like poverty, occupational risks, and overcrowding. Socio-cultural dimensions of health and everyday risks need further understanding among the different communities in the country, allowing for differences in viewpoints and practices based on gender, age, place, and social identity.

Public decisions about COVID-19 vaccines: A UK-based qualitative study

OBJECTIVE

To explore UK public decisions around whether or not to get COVID-19 vaccines, and the facilitators and barriers behind participants' decisions.

DESIGN

This qualitative study consisted of six online focus groups conducted between 15th March and 22nd April 2021. Data were analysed using a framework approach.

SETTING

Focus groups took place via online videoconferencing (Zoom).

PARTICIPANTS

Participants (n = 29) were a diverse group (by ethnicity, age and gender) UK residents aged 18 years and older.

RESULTS

We used the World Health Organization's vaccine hesitancy continuum model to look for, and explore, three main types of decisions related to COVID-19 vaccines: vaccine acceptance, vaccine refusal and vaccine hesitancy (or vaccine delay). Two reasons for vaccine delay were identified: delay due to a perceived need for more information and delay until vaccine was "required" in the future. Nine themes were identified: three main facilitators (Vaccination as a social norm; Vaccination as a necessity; Trust in science) and six main barriers (Preference for "natural immunity"; Concerns over possible side effects; Perceived lack of information; Distrust in government;; Conspiracy theories; "Covid echo chambers") to vaccine uptake.

CONCLUSION

In order to address vaccine uptake and vaccine hesitancy, it is useful to understand the reasons behind people's decisions to accept or refuse an offer of a vaccine, and to listen to them and engage with, rather than dismiss, these reasons. Those working in public health or health communication around vaccines, including COVID-19 vaccines, in and beyond the UK, might benefit from incorporating the facilitators and barriers found in this study.

The interplay of personality traits and motivation in leisure travel decision-making during the pandemic

COVID-19 has negatively affected the travel and tourism industry and may continue to do so in the future. Therefore, hospitality businesses need to pay attention to consumer reactions, concerns, and motives for travelling in this era. This study leverages the stimulus-organism-behaviour-consequence (SOBC) model to examine psychological factors that influence Japanese travellers' intention to travel and willingness to pay premiums for safe travel by analysing data from 790 respondents. The findings of the study reveal that extraversion positively associates with introjected motivation and negatively with amotivation. Neuroticism personality type positively associates with amotivation and negatively associates with introjected motivation. Introjected motivation positively associates with perception of safe travel during COVID-19, whereas amotivation has a non-significant association with perception of safe travel during COVID-19. Perception of safe travel positively associates with intention to travel and willingness to pay premiums for safe travel. Finally, intention to travel has no effect on willingness to pay premiums for safe travel. These findings provide valuable theoretical and managerial implications.

Knowledge of Self-Isolation Rules in the UK for Those Who Have Symptoms of COVID-19: A Repeated Cross-Sectional Survey Study

OBJECTIVES

To investigate knowledge of self-isolation rules and factors associated with knowledge.

METHODS

Repeated cross-sectional online surveys (n ≈ 2000 UK adults) between 9 November 2020 and 16 February 2022 (78,573 responses from 51,881 participants). We computed a composite measure of knowledge of self-isolation rules and investigated associations between knowledge and survey wave, socio-demographic characteristics (age, gender, UK nation, index of multiple deprivation), trust in government, and participants' belief that they had received enough information about self-isolation.

RESULTS

In total, 87.9% (95% CI 87.7% to 88.1%, n = 67,288/76,562) of participants knew that if they had symptoms of COVID-19 they should 'self-isolate'. However, only 62.8% (n = 48,058/76,562, 95% CI 62.4% to 63.1%) knew the main rules regarding what that meant. Younger people had less knowledge than older people, and men had less knowledge than women. Knowledge was lower in people living in England versus in Scotland, Wales, and Northern Ireland. The pattern of association between knowledge and trust in government was unclear. Knowledge was lower in people living in a more deprived area and those who did not believe they had enough information about self-isolation. Knowledge was lower in December 2020 to January 2021, compared with before and after this period.

CONCLUSIONS

Approximately 63% of UK adults between November 2020 and February 2022 appeared to know the main rules regarding self-isolation if symptomatic with COVID-19. Knowledge was lower in younger than older people, men than women, those living in England compared with Scotland, Wales or Northern Ireland, and those living in more deprived areas.

Experiences, Perceptions of Risk, and Lasting Impacts of COVID-19 for Employees in the Public Transport Sector

BACKGROUND

Age-standardized mortality rates for taxi drivers, chauffeurs, bus and coach drivers show that public transport workers were at high risk at the beginning of the COVID-19 pandemic. Nevertheless, the public transport sector was required to continue services throughout the pandemic.

OBJECTIVES

This paper aims to develop a better understanding of the experiences of organizational leaders and workers within the UK public transport sector (bus, rail, and tram). Specifically, it aims to explore the perceived balance of risk and mitigation of SARS-CoV-2 transmission, report on their perceptions of safety in public transport during the pandemic and in the future, and consider how these perceptions and changes impact on long-term worker health and wellbeing.

METHODS

This study formed part of a larger stakeholder engagement with the public transport sector. Organizational leaders and workers were recruited (n = 18) and semi-structured interviews carried out between January and May 2021. Data were analysed thematically.

RESULTS

Overarching and subthemes were identified. Themes relating to perceptions and impacts of risk of COVID-19 for employees included: acceptability of risk for workers, perceptions of risk mitigation effectiveness, changes to working practices and their impact on morale and wellbeing, issues with compliance to mitigations such as social distancing and face coverings in passenger and co-worker groups alongside a lack of power to challenge behaviour effectively, and the roles of leadership and messaging. Themes related to long-lasting impacts of COVID-19 on working practices and effects on health and wellbeing included: continuing mitigations, impact of increasing passenger numbers, impact of vaccination programme, and impact of changes to business structure.

CONCLUSIONS

Most public transport employees reported feeling safe, related to the extent to which their role was public-facing. However, data were collected during a time of very low passenger numbers. Current mitigation measures were thought effective in reducing the risk of viral transmission, although measures may have a detrimental effect on worker morale and wellbeing. Issues relating to non-compliance with guidance and 'in-group' behaviour were identified. Impacts on wider business sustainability and individual wellbeing of staff should be considered when developing responses to any future pandemics. Recommendations are made for prioritizing employee engagement with colleagues, and the importance of strong leadership and clear messaging in promoting adherence to behavioural mitigations.

COVID labour: Making a 'livable' life under lockdown

Drawing on qualitative longitudinal data from 38 families with children in the UK collected between May 2020 and June 2021, this article discusses the extra everyday labour which individuals experienced in going about their daily lives during COVID-19. In particular, we examine in detail the everyday practices of negotiating risk and caring for self and others within the context of the pandemic. We call this COVID labour - the work involved in living through and adjusting to a pandemic. We identify this as constituting three main aspects: seeking and interpreting information; assessing risk; and minimising risk. Like other forms of labour, it is stratified by gender, class and ethnicity. Overall, the analysis contributes to a greater understanding of everyday life 'under lockdown' for families with children, and how 'livable' lives are made under times of great risk.

Effects of scenario-based attribution on collective emotions and stigma toward persons with COVID-19: A cross-sectional survey

Background and Aims

During this COVID-19 pandemic, many people experience and share emotions such as fear, anxiety, sadness, anger, and disgust, which can be regarded as collective emotions. This study investigated the effects of scenario-based attribution for serious diseases on collective emotions and social stigma.

Methods

Participants were 297 healthy adults who met two conditions: (1) not having tested positive for COVID-19 (including their family members or close friends) and no experience of self-quarantine; and (2) not having been diagnosed with lung cancer, and not having family members or close friends diagnosed with it. Three hundred participants were recruited, through a company conducting online surveys. A total of 297 data sets were analyzed, excluding data supplied by three participants who might have responded unreliably to the filler question. Scenarios were recorded according to attribution type (internal vs. external) and disease (COVID-19 vs. lung cancer). A 2 × 2 factorial design was used, whereby participants were randomly assigned to one of four conditions.

Results

The COVID-19 condition showed higher scores on the perceived risk and fear of the disease compared to the lung cancer one. The COVID-19/internal attribution condition showed the highest scores for fear and anger toward scenario characters, and the lung cancer/external attribution condition showed higher sympathy scores than other conditions. Although attribution to COVID-19 was not directly related to social stigma, it could evoke negative emotions toward infected people.

Conclusion

The findings suggest that attributions of serious diseases such as COVID-19 to infected persons can influence collective emotions and the level of social stigma associated with the disease. Attention to the collective emotions and stigma associated with disease is a key component for communities and countries to recover from and respond to its impacts.

Environmental determinants of infectious and chronic disease prevention behaviours: A systematic review and thematic synthesis of qualitative research

Regulatory health policies facilitate desired health behaviours in communities, and among them, smoke-free policies and COVID-19 restrictions have been widely implemented. Qualitative research studies have explored how these measures and other environmental influences shape preventive behaviours. The objective of this systematic review was to synthesize previously published qualitative research, generate across-study themes, and propose recommendations for behaviour change interventions. We used a comprehensive search strategy, relevance screening and confirmation, data extraction, quality assessment, thematic synthesis, and quality-of-evidence assessment. In total, 87 relevant studies were identified. Findings were grouped under six overarching themes and mapped under three categories: (i) the political environment, (ii) the sociocultural environment, and (iii) the physical environment. These findings provide insights into the environmental influences of behaviour and indicate future interventions may be more effective by considering moral norms, community norms, policy support, and group identity.

How health beliefs and sense of control predict adherence to COVID-19 prevention guidelines among young adults in South Korea

This study defined adherence to COVID-19 prevention guidelines as health behavior and examined whether the two constructs of the health belief model (i.e., perceived susceptibility and perceived severity) and sense of control predict the level of adherence among young adults in South Korea. An online survey (N = 200) conducted in June 2021, showed that perceived susceptibility, perceived severity, and sense of control positively predict adherence behavior. Sense of control significantly moderated the relationship between perceived susceptibility and adherence even after controlling for depression and perceived health status. Specifically, individuals with a lower level of perceived susceptibility still adhered to COVID-19 prevention guidelines if they had a higher level of sense of control. The finding demonstrates the key role of sense of control in promoting adherence to COVID-19 prevention guidelines and the relationship between sense of control and two constructs of the health belief model. Implication for public messaging targeted at young adults during pandemic situations is also discussed.

Perceived legitimacy can moderate the effect of proscriptive versus prescriptive injunctions on intentions to comply with UK government COVID-19 guidelines and reactance

Proscriptive injunctions (i.e., telling people what they should not do) have been found in research to elicit greater perceptions of a threat to freedom, and greater reactance (anger, irritation and annoyance), than prescriptive injunctions (i.e., telling people what they should do), across several health and social behaviors. The current research investigated the effects of Injunction Type (proscriptive vs. prescriptive) and perceived legitimacy of the injunction, on intentions to comply with UK government behavioral guidelines during the COVID-19 pandemic, and on reactance. In two online experimental studies (Study 1: N = 142; Study 2: N = 307), UK participants were presented with information about UK government COVID-19 guidelines that included either a proscriptive injunction or prescriptive injunction and reported their perceptions of the legitimacy of the injunction, their intentions to comply with government guidelines, and their reactance. In both Study 1 and Study 2, the effect of Injunction Type on intentions to comply and reactance was moderated by perceived legitimacy. In both studies, when perceived legitimacy was low, participants exposed to the proscriptive injunction indicated lower intentions to comply with UK government COVID-19 guidelines than did participants exposed to the prescriptive injunction. The findings imply that using a prescriptive injunction frame can elicit greater intentions to comply than using a proscriptive injunction frame when people perceive the injunction to be unreasonable. The results are discussed in relation to the role of legitimacy in determining the effectiveness of different types of injunctions on compliance with rules and guidelines.

Translation, Adaptation and Validation of the Pandemic Fatigue Scale (PFS) in the Greek Language

The growing fatigue of citizens due to the COVID-19 pandemic has already been addressed and its results are visible and threatens citizen compliance. The aim of this study was to translate and validate the Pandemic Fatigue Scale (PFS) in the Greek language. A cross-sectional study was conducted between October 2021 to March 2022. The translation and cultural adaptation process was developed according to the research protocols among the university student population in Cyprus and tested the psychometric properties of PFS. Three hundred thirty-four subjects participated in the study through a web survey, which included general information and the study process. The internal consistency for the total PFS showed good reliability (six items, a = 0.88). A weak statistically significant positive correlation was found between the PFS and the Greek versions of Generalised Anxiety Disorder Assessment—GAD-7 (r = 0.1.96; p < 0.001) and the PFS and Patient Health Questionnaire—PHQ-9 (r = 0.173; p = 0.002) demonstrating good concurrent validity. Recovering from the pandemic, it is necessary to build systems to detect and respond to future healthcare crises. The results suggest that the psychometric properties of the Greek PFS are satisfactory. The measure of pandemic fatigue allows for identifying fatigue groups for targeted interventions and testing how pandemic fatigue might be reduced in such situations.

Public perceptions and interactions with UK COVID-19 Test, Trace and Isolate policies, and implications for pandemic infectious disease modelling

Background The efforts to contain SARS-CoV-2 and reduce the impact of the COVID-19 pandemic have been supported by Test, Trace and Isolate (TTI) systems in many settings, including the United Kingdom. Mathematical models of transmission and TTI interventions, used to inform design and policy choices, make assumptions about the public’s behaviour in the context of a rapidly unfolding and changeable emergency. This study investigates public perceptions and interactions with UK TTI policy in July 2021, assesses them against how TTI processes are conceptualised and represented in models, and then interprets the findings with modellers who have been contributing evidence to TTI policy. Methods 20 members of the public recruited via social media were interviewed for one hour about their perceptions and interactions with the UK TTI system. Thematic analysis identified key themes, which were then presented back to a workshop of pandemic infectious disease modellers who assessed these findings against assumptions made in TTI intervention modelling. Workshop members co-drafted this report. Results Themes included education about SARS-CoV-2, perceived risks, trust, mental health and practical concerns. Findings covered testing practices, including the uses of and trust in different types of testing, and the challenges of testing and isolating faced by different demographic groups. This information was judged as consequential to the modelling process, from guiding the selection of research questions, influencing choice of model structure, informing parameter ranges and validating or challenging assumptions, to highlighting where model assumptions are reasonable or where their poor reflection of practice might lead to uninformative results. Conclusions We conclude that deeper engagement with members of the public should be integrated at regular stages of public health intervention modelling.

Patient and clinician perspectives of ophthalmology emergency attendances during the COVID 19 pandemic

Introduction

To explore patient and clinician perspectives on acute ophthalmology presentations during the COVID pandemic. To ascertain whether the pandemic had differentially impacted access to care based on patient demographics and postcodes.

Methods

A single-centre, cross-sectional prospective study in a busy metropolitan eye casualty between April-June 2020 recording patient demographics, distance travelled to access healthcare, diagnosis and outcome compared to the equivalent period in 2019. A further two-part survey was conducted to explore patient and clinician's perceptions around delays in attendances, views on remote consultation and severity of the condition.

Results

There was a 68% decrease in April 2020 compared to previous year's ED attendance. The diagnosis tended towards more visually significant pathology. From 2019 to 2020, there was a significant decrease in average distance travelled to the eye emergency department (eye ED). working-age adults (18-59) and white patients travelling from very far pre-pandemic contributed most to this change. 513 Patient responses (12%) out of 4433 attendances during the study period were received, 89% (456/513) of the completed surveys also had matching clinician surveys. 29% (149/513) patients felt COVID-19 stopped them from attending earlier. Clinicians thought a video consultation would have been suitable for 40% (182/456) of patients compared to only 13% (58/456) of patients preferring a video consultation.

Discussion

Although our findings were limited by low response rates, COVID-19 may have caused a delay in presentation for emergency eye care. Demographic changes and attitudes towards video consultations have implications for planning of emergency eye care in future pandemics.

Trust in the U.S. Government and Its Health Agencies in the Time of COVID-19

This article examines the factors affecting Americans' trust in their federal government and its health agencies during the COVID-19 public health crisis. More specifically, we examine the evolution of Americans' trust in their government and health system and how, in the context of the COVID-19 pandemic response, it has been affected by multiple factors. Several academic journals, government policy recommendations and public health polls were evaluated to understand the public's trust in the federal government and its health institutions. Public trust in institutions during a global pandemic is essential in influencing adherence to a pandemic response (both non-pharmaceutical and medical interventions). Americans' trust in institutions is built and maintained by a variety of factors. We focus on: political polarization and involvement, media influence and health communications, history of systemic racism and socioeconomic inequalities, and pandemic fatigue. Based on the interplay of these factors, we conclude with recommendations for future pandemic response strategies.

Tiered restrictions for COVID-19 in England: knowledge, motivation and self-reported behaviour

OBJECTIVES

To test whether public knowledge and confidence in one's understanding of the local restrictions, motivation to adhere to local restrictions, and self-reported behaviour (going out for exercise, to work, socially) differed according to tier level.

STUDY DESIGN

Cross-sectional, nationally representative, online survey of 1728 participants living in England (data collection: 26 to 28 October 2020).

METHODS

We conducted logistic regression analyses to investigate whether knowledge of restrictions, confidence in knowledge of restrictions, motivation to adhere to restrictions, and self-reported behaviour were associated with personal characteristics and tier.

RESULTS

Between 81% (tier 2) and 89% (tier 3) of participants correctly identified which tier they lived in. Knowledge of specific restrictions was variable. 73% were confident that they understood which tier was in place in their local area, whereas 71% were confident they understood the guidance in their local area. Confidence was associated with being older and living in a less deprived area. 73% were motivated to adhere to restrictions in their local area. Motivation was associated with being female and older. People living in tiers with greater restrictions were less likely to report going out to meet people from another household socially; reported rates of going out for exercise and for work did not differ.

CONCLUSIONS

Although recognition of local tier level was high, knowledge of specific guidance for tiers was variable. There was some indication that nuanced guidance (e.g. behaviour allowed in some settings but not others) was more poorly understood than guidance which was absolute (i.e. behaviour is either allowed or not allowed).

Perceived COVID-19 Threat and Reactions to Noncompliant Health-Protective Behaviors: The Mediating Role of Desired Cultural Tightness and the Moderating Role of Age

The COVID-19 pandemic is a health crisis that requires individuals to comply with many health-protective behaviors. Following the previous literature, cultural tightness has been found to be a key mechanism to increase coordination in order to mitigate collective threats (e.g., COVID-19). In this study, we test a moderated mediation model to examine whether the perceived COVID-19 threat could intensify the extent of desired tightness (i.e., a personal desire for cultural tightness), moderated by age. Subsequently, we test whether this could intensify individuals' emotional reactions to non-compliance with COVID-19 health protective behaviors. The study relies on a cross-sectional design, with a sample of 624 participants residing in central Italy (i.e., Lazio). The data were collected from February to October 2021. Questionnaires contained self-reporting measures of the perceived COVID-19 threat, desired tightness, and personal emotional reactions to non-compliance with COVID-19 preventive measures (e.g., wearing a mask). The results confirm that the perceived COVID-19 threat is associated with an increase in the desire for cultural tightness-and that this relationship was moderated by age-and, consequently, with intolerance for noncompliance with preventive behaviors. Additionally, both direct and indirect effects of the perceived COVID-19 threat on negative emotional reactions to noncompliance were significant; this indirect effect was larger at high (+1 SD) age than at low (-1 SD) age. Overall, this research provides some insight into how people can respond to the current pandemic threat, and how this may have implications for violating rules and regulations to keep contagion under control.

Information seeking behaviours and uncertainty around accessing primary care in the changing landscape of the COVID-19 pandemic: a qualitative study

Background

The COVID-19 pandemic has had and will continue to have a disproportionate effect on the most vulnerable. Public health messaging has been vital to mitigate the impact of the pandemic, but messages intended to slow the transmission of the virus may also cause harm. Understanding the areas where public health messaging could be improved may help reduce this harm.

Aim

To explore and understand health communication issues faced by those most likely to be impacted by the COVID-19 pandemic.

Design & setting

A qualitative study using online surveys. The area of focus was Fife, a local authority in Scotland, UK.

Method

Two consecutive surveys were conducted. Survey 1 explored the observations of support workers and Facebook group moderators, and focused on key issues faced by service users, as well as examples of good practice (n = 19). Survey 2 was aimed at community members, and focused on issues regarding access to and communication around access to primary care (n = 34).

Results

Survey 1 found broad issues around communication and access to primary care services. Survey 2 emphasised key issues in accessing primary care, including: (a) the lengthy process of making appointments; (b) feeling like a burden for wanting to be seen; (c) a lack of confidence in remote triaging and consultations; and (d) not knowing what to expect before getting an appointment.

Conclusion

Clear issues regarding access to primary care were identified. The new understanding of these issues will inform a co-creation process designed to develop clear, actionable, and effective public health messages centred on improving access to primary care.