Predictors of changing patterns of adherence to containment measures during the early stage of COVID-19 pandemic: an international longitudinal study

(2023) 19:25 Chong et al. Globalization and Health https://doi.org/10.1186/s12992-023-00928-7 Globalization and Health Open Access RESEARCH Predictors of changing patterns of adherence to containment measures during the early stage of COVID‑19 pandemic: an international longitudinal study Yuen Yu Chong1* , Wai Tong Chien1, Ho Yu Cheng1, Demetris Lamnisos2, Jeļena Ļubenko3, Giovambattista Presti4, Valeria Squatrito4, Marios Constantinou5, Christiana Nicolaou6, Savvas Papacostas7, Gökçen Aydin8, Francisco J. Ruiz9, Maria B. Garcia‑Martin10, Diana P. Obando‑Posada10, Miguel A. Segura‑Vargas9, Vasilis S. Vasiliou11, Louise McHugh12, Stefan Höfer13, Adriana Baban14, David Dias Neto15, Ana Nunes da Silva16,17, Jean‑Louis Monestès18, Javier Alvarez‑Galvez19, Marisa Paez Blarrina20, Francisco Montesinos21, Sonsoles Valdivia Salas22, Dorottya Őri23, Bartosz Kleszcz24, Raimo Lappalainen25, Iva Ivanović26, David Gosar27, Frederick Dionne28, Rhonda M. Merwin29, Andrew T. Gloster30, Angelos P. Kassianos31,32 and Maria Karekla31 Abstract Background Identifying common factors that affect public adherence to COVID-19 containment measures can directly inform the development of official public health communication strategies. The present international longitu‑ dinal study aimed to examine whether prosociality, together with other theoretically derived motivating factors (selfefficacy, perceived susceptibility and severity of COVID-19, perceived social support) predict the change in adherence to COVID-19 containment strategies. Method In wave 1 of data collection, adults from eight geographical regions completed online surveys beginning in April 2020, and wave 2 began in June and ended in September 2020. Hypothesized predictors included prosociality, self-efficacy in following COVID-19 containment measures, perceived susceptibility to COVID-19, perceived sever‑ ity of COVID-19 and perceived social support. Baseline covariates included age, sex, history of COVID-19 infection and geographical regions. Participants who reported adhering to specific containment measures, including physical distancing, avoidance of non-essential travel and hand hygiene, were classified as adherence. The dependent variable was the category of adherence, which was constructed based on changes in adherence across the survey period and included four categories: non-adherence, less adherence, greater adherence and sustained adherence (which was designated as the reference category). Results In total, 2189 adult participants (82% female, 57.2% aged 31–59 years) from East Asia (217 [9.7%]), West Asia (246 [11.2%]), North and South America (131 [6.0%]), Northern Europe (600 [27.4%]), Western Europe (322 [14.7%]), Southern Europe (433 [19.8%]), Eastern Europe (148 [6.8%]) and other regions (96 [4.4%]) were analyzed. Adjusted *Correspondence: Yuen Yu Chong Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Chong et al. Globalization and Health (2023) 19:25 Page 2 of 11 multinomial logistic regression analyses showed that prosociality, self-efficacy, perceived susceptibility and severity of COVID-19 were significant factors affecting adherence. Participants with greater self-efficacy at wave 1 were less likely to become non-adherence at wave 2 by 26% (adjusted odds ratio [aOR], 0.74; 95% CI, 0.71 to 0.77; P < .001), while those with greater prosociality at wave 1 were less likely to become less adherence at wave 2 by 23% (aOR, 0.77; 95% CI, 0.75 to 0.79; P = .04). Conclusions This study provides evidence that in addition to emphasizing the potential severity of COVID-19 and the potential susceptibility to contact with the virus, fostering self-efficacy in following containment strategies and prosociality appears to be a viable public health education or communication strategy to combat COVID-19. Keywords Prosociality, Coronavirus, Adherence, Disease containment measures, Longitudinal study Introduction Since the outbreak of coronavirus disease (COVID-19) in 2019, government leaders worldwide have used various measures to contain its spread, such as physical distancing, avoiding large gatherings, wearing masks and frequent hand washing [1]. Research has been conducted to assess the impact of these containment measures [2]. For instance, cancelling small gatherings has been found to decrease the effective reproduction number of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Rt) by up to 83% [3]; while self-isolation, household quarantine and manual contact tracing can reduce COVID-19 transmission up to 64% [4]. Public adherence to disease containment measures remains crucial for controlling the spread of COVID-19. However, such adherence varies depending on the types of measures required to be complied with, the intensities of governmental enforcement measures and is influenced by the interplay of demographic, political, and sociocultural factors [5–7]. In a longitudinal study conducted between March and December 2020 involving 238,797 participants from 14 countries, adherence to lowercost and habituating behaviors (e.g., mask-wearing in crowded areas) was found to increase progressively over time [8], while adherence to high-cost, sensitizing behaviors (e.g., physical distancing, avoiding crowds) gradually decreased due to pandemic fatigue (i.e., overall tiredness or demotivation to follow recommended protective behaviors) and reduced risk perception of COVID-19 [8]. Psychological factors that influence adherence to COVID-19 related protective behaviors have been recently examined in several theoretical frameworks [6]. The Health Belief Model [9], the Social Cognitive Theory[10], the Reasoned Action Approach [11] and the Health Action Process Approach are theories centered around self-motivation that have been increasingly adopted in COVID-19-related research [12, 13]. These theories suggest that increased self (...truncated)