Contextualising COVID-19 prevention behaviour over time in Australia: Patterns and long-term predictors from April to July 2020 in an online social media sample

From facts to feelings: Navigating the complexities of COVID-19 restrictions, perceptions, and mental well-being

Objectives of the present study were to 1) examine accuracy of COVID-19 public health restriction knowledge and the impact of information source, 2) assess the effect of perceived level of restriction on perceived infection risk of COVID-19 infection and level of compliance with restrictions, and 3) investigate the relationship between mental health outcomes and perceived as well as actual level of restriction. Canadians (n = 5,051) completed an online survey between December 2020 and March 2021 assessing public health restriction knowledge, accuracy of this knowledge, information sources about COVID-19, perceived infection risk, compliance with restrictions, loneliness, anxiety, and depressive symptoms. Approximately half of our sample had accurate knowledge of the restrictions in their region/province, which significantly differed by province. Individuals who perceived restriction levels to be higher than they were, reported significantly greater perceived infection risk, more compliance with restrictions, worse mental health, and greater loneliness. Individuals living under moderate restrictions had better mental health and experienced less loneliness compared to minor, significant and extreme restriction levels. Findings suggest that while restrictions are beneficial for compliance, stronger and clearer restrictions should be coupled with mental health supports to remediate the negative effects of restrictions and uncertainty on mental health and loneliness.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Addressing Behavioral Barriers to COVID-19 Testing With Health Literacy-Sensitive eHealth Interventions: Results From 2 National Surveys and 2 Randomized Experiments

BACKGROUND

Polymerase chain reaction (PCR) testing for COVID-19 was crucial in Australia's prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact with cases, travel, and certain professions. However, several months into the pandemic, half of Australians were still not getting tested for respiratory symptoms, and little was known about the drivers of and barriers to COVID-19 PCR testing as a novel behavior at that time.

OBJECTIVE

We aimed to identify and address COVID-19 testing barriers, and test the effectiveness of multiple eHealth interventions on knowledge for people with varying health literacy levels.

METHODS

The intervention was developed in 4 phases. Phase 1 was a national survey conducted in June 2020 (n=1369), in which testing barriers were coded using the capability-opportunity-motivation-behavior framework. Phase 2 was a national survey conducted in November 2020 (n=2034) to estimate the prevalence of testing barriers and health literacy disparities. Phase 3 was a randomized experiment testing health literacy-sensitive written information for a wide range of barriers between February and March 2021 (n=1314), in which participants chose their top 3 barriers to testing to view a tailored intervention. Phase 4 was a randomized experiment testing 2 audio-visual interventions addressing common testing barriers for people with lower health literacy in November 2021, targeting young adults as a key group endorsing misinformation (n=1527).

RESULTS

In phase 1, barriers were identified in all 3 categories: capability (eg, understanding which symptoms to test for), opportunity (eg, not being able to access a PCR test), and motivation (eg, not believing the symptoms are those of COVID-19). Phase 2 identified knowledge gaps for people with lower versus higher health literacy. Phase 3 found no differences between the intervention (health literacy-sensitive text for top 3 barriers) and control groups. Phase 4 showed that a fact-based animation or a TikTok-style video presenting the same facts in a humorous style increased knowledge about COVID-19 testing compared with government information. However, no differences were found for COVID-19 testing intentions.

CONCLUSIONS

This study identified a wide range of barriers to a novel testing behavior, PCR testing for COVID-19. These barriers were prevalent even in a health system where COVID-19 testing was free and widely available. We showed that key capability barriers, such as knowledge gaps, can be improved with simple videos targeting people with lower health literacy. Additional behavior change strategies are required to address motivational issues to support testing uptake. Future research will explore health literacy strategies in the current context of self-administered rapid antigen tests. The findings may inform planning for future COVID-19 variant outbreaks and new public health emergencies where novel testing behaviors are required.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12621000876897, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382318 ; Australian New Zealand Clinical Trials Registry ACTRN12620001355965, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380916&isReview=true.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Predictive capacity of COVID-19-related risk beliefs on weight management behaviors on a commercial weight loss program and speed of COVID-19 vaccination uptake: prospective cohort study

BACKGROUND

Recent work has shown that obesity may be a risk factor for severe COVID-19. However, it is unclear to what extent individuals have heard or believe this risk factor information, and how these beliefs may predict their preventive behaviors (e.g., weight management behaviors or COVID-19 preventive behaviors). Previous work has primarily looked at overall risk likelihood perceptions (i.e., not about obesity as a risk factor) within general populations of varying weight and concentrated on COVID-19-related preventive behaviors. Therefore, this prospective cohort study explored whether beliefs about obesity as a risk factor and overall risk likelihood perceptions predicted weight management and COVID-19 preventive behaviors over the next 16 weeks in individuals with obesity or overweight.

METHODS

Participants were 393 individuals in the US who joined a commercial weight management program in January, 2021. We leveraged the mobile program's automatic measurement of real-time engagement in weight management behaviors (e.g., steps taken), while surveys measured risk beliefs at baseline as well as when individuals received COVID-19 vaccination doses (asked monthly) over the next 16 weeks. Mixed effects models predicted engagement and weight loss each week for 16 weeks, while ordinal logistic regression models predicted the month that individuals got vaccinated against COVID-19.

RESULTS

We found that belief in obesity as a risk factor at baseline significantly predicted greater engagement (e.g., steps taken, foods logged) in program-measured weight management behaviors over the next 16 weeks in models adjusted for baseline BMI, age, gender, and local vaccination rates (minimally adjusted) and in models additionally adjusted for demographic factors. Belief in obesity as a risk factor at baseline also significantly predicted speed of COVID-19 vaccination uptake in minimally adjusted models but not when demographic factors were taken into account. Exposure to obesity risk factor information at baseline predicted greater engagement over 16 weeks in minimally adjusted models.

CONCLUSIONS

The results highlight the potential utility of effective education to increase individuals' belief in obesity risk factor information and ultimately promote engagement or faster vaccination. Future research should investigate to what extent the results generalize to other populations.

Social cognitive predictors of vaccination status, uptake and mitigation behaviors in the Canadian COVID-19 Experiences survey

Emerging infectious diseases like COVID-19 will remain a concern for the foreseeable future, and determinants of vaccination and other mitigation behaviors are therefore critical to understand. Using data from the first two waves of the Canadian COVID-19 Experiences Survey (CCES; N = 1,958; 66.56 % female), we examined social cognitive predictors of vaccination status, transition to acceptance and mitigation behaviors in a population-representative sample. Findings indicated that all social cognitive variables were strong predictors of mitigation behavior performance at each wave, particularly among unvaccinated individuals. Among those who were vaccine hesitant at baseline, most social cognitive variables predicted transition to fully vaccinated status at follow-up. After controlling for demographic factors and geographic region, greater odds of transitioning from unvaccinated at CCES Wave 1 to fully vaccinated at CCES Wave 2 was predicted most strongly by a perception that one's valued peers were taking up the vaccine (e.g., dynamic norms (OR = 2.13 (CI: 1.54,2.93)), perceived effectiveness of the vaccine (OR = 3.71 (CI: 2.43,5.66)), favorable attitudes toward the vaccine (OR = 2.80 (CI: 1.99,3.95)), greater perceived severity of COVID-19 (OR = 2.02 (CI: 1.42,2.86)), and stronger behavioral intention to become vaccinated (OR = 2.99 (CI: 2.16,4.14)). As a group, social cognitive variables improved prediction of COVID-19 mitigation behaviors (masking, distancing, hand hygiene) by a factor of 5 compared to demographic factors, and improved prediction of vaccination status by a factor of nearly 20. Social cognitive processes appear to be important leverage points for health communications to encourage COVID-19 vaccination and other mitigation behaviors, particularly among initially hesitant members of the general population.

Collateral positives of COVID-19 for culturally and linguistically diverse communities in Western Sydney, Australia

BACKGROUND

To investigate whether culturally and linguistically diverse (CALD) communities in Western Sydney have experienced any positive effects during the COVID-19 pandemic, and if so, what these were.

METHODS

A cross-sectional survey with ten language groups was conducted from 21st March to 9th July 2021 in Sydney, Australia. Participants were recruited through bilingual multicultural health staff and health care interpreter service staff and answered a question, 'In your life, have you experienced any positive effects from the COVID-19 pandemic?' Differences were explored by demographic variables. Free-text responses were thematically coded using the Content Analysis method.

RESULTS

707 people completed the survey, aged 18 to >70, 49% males and 51% females. Only 161 (23%) of those surveyed reported any positive impacts. There were significant differences in the proportion of those who reported positives based on age (p = 0.004), gender (p = 0.013), language (p = 0.003), health literacy (p = 0.014), English language proficiency (p = 0.003), education (p = <0.001) and whether participants had children less than 18 years at home (p = 0.001). Content Analysis of open-ended responses showed that, of those that did report positives, the top themes were 'Family time' (44%), 'Improved self-care' (31%) and, 'Greater connection with others' (17%).

DISCUSSION

Few surveyed participants reported finding any positives stemming from the COVID-19 pandemic. This finding is in stark contrast to related research in Australia with participants whose native language is English in which many more people experienced positives. The needs of people from CALD backgrounds must inform future responses to community crises to facilitate an equitable effect of any collateral positives that may arise.

SARS-CoV-2 in brief: from virus to prevention

The recent outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), ahighly transmissible virus with a likely animal origin, has posed major and unprecedentedchallenges to millions of lives across the affected nations of the world. This outbreak firstoccurred in China, and despite massive regional and global attempts shortly thereafter, itspread to other countries and caused millions of deaths worldwide. This review presents keyinformation about the characteristics of SARS-CoV-2 and its associated disease (namely,coronavirus disease 2019) and briefly discusses the origin of the virus. Herein, we also brieflysummarize the strategies used against viral spread and transmission.

Trajectories of Compliance With COVID-19 Related Guidelines: Longitudinal Analyses of 50,000 UK Adults

BACKGROUND

Governments have implemented a range of measures focused on changing citizens' behaviors to lower the transmission of COVID-19. While international data shows that compliance did decline from the start of the pandemic, average trends could mask considerable heterogeneity in compliance behaviors.

PURPOSE

To explore trajectories of compliance with COVID-19 guidelines.

METHODS

We used longitudinal data on self-reported compliance from 50,851 adults in the COVID-19 Social Study collected across two waves of the pandemic in the UK (April 01, 2020-February 22, 2021). We modeled typical compliance trajectories using latent class growth analysis (LCGA) and used multinomial logistic regression to examine whether individual personality and demographic characteristics were related to compliance trajectories.

RESULTS

We selected a four-class LCGA solution. Most individuals maintained high levels of compliance and reported similar levels of compliance across the first and second waves. Approximately 15% of participants had decreasing levels of compliance across the pandemic, reporting noticeably lower levels of compliance in the second wave. Individuals with declining compliance levels were younger on average, in better physical health, had lower empathy and conscientiousness and greater general willingness to take risks.

CONCLUSIONS

While a minority, not all individuals have maintained high compliance across the pandemic. Decreasing compliance is related to several psychological traits. The results suggest that targeting of behavior change messages later in the pandemic may be needed to increase compliance.

A pre- and post-intervention study testing the effect of exposure to languageless animated images communicating COVID-19 preventive behaviours on behavioural intentions and beliefs of Guatemalan adults

Background

Effective health communication to encourage participation in COVID-19 preventive behaviours is crucial in helping mitigate viral spread. Intentions and beliefs are known determinants of adherence to these behaviours, therefore, health communication interventions based on these constructs may be effective. Visual languageless messages can be particularly useful in multilingual countries, where text-based communications can limit message exposure. This pre- and post-intervention study sought to identify the effect of exposure to languageless animated messages, presented in the Graphic Interchange Format (GIF), communicating COVID-19 preventive behaviours (physical distancing, handwashing, and mask-wearing) on behavioural intentions and beliefs.

Methods

Between February and March 2021, a nationally representative sample of 308 Guatemalan adults completed this online survey experiment. Self-reported performance of preventive behaviours, understanding of COVID-19 transmission risk, as well as intentions, self-efficacy, and outcome expectancy beliefs about preventive behaviours were assessed at baseline. Participants were then exposed to a random combination of three of four possible GIFs in random presentation order. Following exposure to each GIF, intentions, self-efficacy, and outcome expectancy beliefs were reassessed.

Results

In terms of main effects, GIF exposure was significantly associated with improved intentions, self-efficacy, and outcome expectancy beliefs in relation to physical distancing; intentions and outcome expectancy beliefs in relation to handwashing; and intentions and self-efficacy in relation to mask-wearing. These associations were not dependent on the combination of the three of four possible GIFs presented. Pairwise comparisons revealed that observed improvements in scores were most pronounced from baseline to the first GIF exposure and reduced thereafter.

Conclusions

Exposure to languageless GIFs communicating COVID-19 preventive behaviours is associated with improvements in key social-cognitive determinants of those behaviours. Dosage of GIF exposure and durability of effects are issues that warrant further attention so we can better understand the conditions and point at which benefits are maximised. Moreover, the effect on behavioural adherence is yet to be determined. GIFs provide a valuable means to widely disseminate health messages via social media during public health crises, such as COVID-19. When these messages are languageless, the potential reach of dissemination can be maximised.

COVID-safe behaviour before, during and after a youth mass gathering event: a longitudinal cohort study

OBJECTIVE

As mass gathering events resume in the wake of the COVID-19 pandemic, there is a pressing need to understand (a) engagement in COVID-safe behaviour at these events and (b) how attending a mass gathering impacts subsequent behaviours. This study examined anticipated COVID-safe behaviour before, during, and after a youth mass gathering event.

DESIGN

Longitudinal cohort study.

SETTING

Self-report data were collected online at five timepoints from secondary-school graduates participating in celebrations linked to an annual week-long youth mass gathering event in Australia.

PARTICIPANTS

Australian secondary-school graduates completed surveys before the event (N=397), on days 1 (N=183), 3 (N=158) and 5 (N=163) of the event, and 3 weeks after the event (N=140). Of those who completed the first survey, 72 indicated they would attend a primary mass gathering site where the largest mass gathering of graduates in Australia occurs in a typical (non-pandemic) year; 325 indicated they would be celebrating at other locations (ie, secondary sites).

PRIMARY OUTCOME MEASURES

Anticipated COVID-safe behaviour: physical distancing from friends and strangers and additional protective behaviours (hand hygiene and mask wearing).

RESULTS

At all timepoints, participants anticipated maintaining appropriate (>1.5 m) physical distance from strangers, but not from friends (<0.5 m). Attendees at the primary site reported less physical distancing from friends over time throughout the mass gathering, χ²(4)=16.89, p=0.002. Physical distancing from strangers, χ²(4)=26.93, p<0.001, and additional protective behaviours, χ²(4)=221.23, p<0.001, also declined across the mass gathering among both groups. These reductions in COVID-safe behaviour were significant and enduring, with all declines persisting at follow-up.

CONCLUSION

It is critical that public health messaging and interventions emphasise the risks of disease transmission arising from other attendees who are known to us during mass gathering events, and that such messaging is sustained during and following the event to combat reductions in COVID-safe behaviour.

The Roles of Health and e-Health Literacy, Conspiracy Beliefs and Political Sympathy in the Adherence to Preventive Measures Recommended during the Pandemic

Adherence to preventive measures is of the utmost importance for limiting the spreading of the coronavirus. Many predictors of adopting preventive behaviors have been analyzed in different countries during the COVID-19 pandemic. Objectives: The study’s main aim was to assess the roles of health (HL) and e-health literacy (eHL), conspiracy beliefs, political sympathy, and religious practices in the adherence to COVID-19 preventive measures after adjusting for sociodemographic factors. The analysis was based on the data obtained from a survey conducted among 2410 adult Internet users in Poland in October 2020. The survey was performed with a computer-assisted web-based interviewing technique. Survey data were analyzed through uni- and multivariable linear regression models. The multivariable regression model revealed that after adjusting for sociodemographic variables, the preventive measures score (PMS) was significantly associated with HL (B = 0.04, p < 0.001), eHL (B = 0.03, p < 0.001) and the COVID-19-related conspiracy beliefs score (C19CBS) (B = −0.24, p < 0.001). There was also a significant statistical relationship between PMS and political sympathies and religious practices. HL and eHL are key factors eligible for modification through appropriate interventions and showing positive effects in compliance with preventive measures. Conspiracy beliefs, political sympathy and religious beliefs are independently associated with the adherence.

Longitudinal changes in COVID-19 concern and stress: Pandemic fatigue overrides individual differences in caution

Background:

Pandemic fatigue describes a phenomenon whereby individuals experience a decrease in COVID-19 concern over time, despite their risk for infection remaining stable, or even increasing. Individual differences in the experience of pandemic fatigue may have important implications for people’s adherence to public health recommendations.

Design and methods:

Using data collected from a large community cohort in McLennan County, TX, longitudinal changes in COVID-19-related concern, stress, and affect across three appointments separated by approximately 4 weeks (July–November 2020) were examined. About 495, 349, and 286 participants completed one, two, and three appointments, respectively. Changes to stress physiology and local travel over time were also analyzed.

Results:

Results of a latent class growth analysis revealed four distinct classes of individuals: (a) low concern, low stress, (b) moderate concern, moderate stress, (c) moderate concern, low stress, and (d) high concern, high stress. Despite differences between latent classes in initial levels of concern, stress, and negative affect, levels of each variable decreased over time for all groups. While this reduction of concern did not coincide with changes in local travel, it was reflected in heart rate and blood pressure.

Conclusions:

Together, these results suggest a general trend of pandemic fatigue in the sample, even for those with moderate-to-high levels of initial COVID-19 stress and concern. Such findings may provide insights into the expected challenges of promoting compliance with public health recommendations as the pandemic continues.

The effect of habit on preventive behaviors: a two-wave longitudinal study to predict COVID-19 preventive behaviors

Objective: The COVID-19 pandemic is a continuing global threat. This study examined the effect of habit on the motivational aspects of COVID-19 preventive behaviors using a dual-motivation model, which hypothesizes that intentional and reactive motivations determine behavior. This study assumes that habit influences behaviors through the antecedents of the model and the interaction effects of intentional motivation × habit and reactive motivation × habit.

Design: This study conducted a longitudinal survey of 300 Japanese participants to predict preventive behaviors two weeks after the first survey. Moreover, it measured past and future COVID-19 self-reported preventive behaviors, attitudes, behavioral intentions, behavioral willingness, subjective and descriptive norms, self-efficacy, behavioral controls, and habits.

Results: The results showed the interaction effects of behavioral intention × habit and behavioral willingness × habit on preventive behaviors in addition to the effect of past behavior. The stronger the effect of habit, the stronger is the effect of behavioral intention and the weaker the effect of behavioral willingness.

Conclusion: The habituation of preventive behaviors strengthens the behavioral intention–behavior consistency. This study suggested that habit is an important factor for overcoming psychological barriers and for establishing preventive behaviors in daily life.

Assessment of Dietary and Lifestyle Responses After COVID-19 Vaccine Availability in Selected Arab Countries

Background

The COVID-19 pandemic has been consistently associated with unhealthy lifestyle behaviors and dietary practices. This study aimed to assess the dietary and lifestyle behaviors of adults after COVID-19 vaccine availability and their attitude toward the vaccine in selected Arab countries.

Methods

A cross-sectional survey-based study was conducted between October 2021 and December 2021 using Google Forms (n = 2259). A multi-component questionnaire was used to collect socio-demographic characteristics, attitudes toward the COVID-19 vaccine, and behavioral, dietary, and lifestyle responses after easing the restriction. Participants were given a score based on the sum of positive dietary and lifestyle changes. The generalized linear models were used to identify the association between positive dietary and lifestyle changes score and sociodemographic characteristics.

Results

Weight gain during the pandemic was reported by 39.5% of the participants, 36.1% reported ever getting infected with the COVID-19 virus, and 85% received at least one dose of the vaccine. The key adverse reactions of the COVID-19 vaccine were fatigue, headache, and joint pain, and the main reason for vaccination was protection against infection. Most participants were concerned about the vaccine side effects (45.8%) and inadequate testing (50.7%). After easing of restriction, 54.3% of the participants reduced the frequency of disinfecting objects, and 58.3% joined social events. Most dietary and lifestyle behaviors remained unchanged after vaccine availability but there was an increase in the time spent behind the screen for work (50.1%) and entertainment (42.9%). The results of the multivariate regression analyses revealed that older participants (p = 0.001), those with higher education (p = 0.010), and those working from home (p = 0.040) were more likely to have higher positive dietary and lifestyle changes scores.

Conclusion

Although most participants were concerned about vaccine safety, low vaccine hesitancy rates were observed among the study sample. The availability of the COVID-19 vaccines resulted in loosening some of the safety social measures among Arab adults but the negative impact of the pandemic on dietary and lifestyle behaviors remained unaltered.