Psychosocial determinants of adherence to COVID-19 preventive behaviors

BACKGROUND: Non-adherence to medical guidelines is associated with suboptimal health outcomes and increased healthcare costs, and yet adherence to preventive therapies is often difficult to achieve. Understanding which factors can improve adherence is a public health priority. In this study, we examined the association of psychosocial factors and adherence of preventive behaviors within the context of the COVID-19 pandemic. METHODS: Panel data from the European COvid Survey (ECOS), a representative sample of residents aged 18+ from Germany, United Kingdom, Denmark, Netherlands, France, Portugal and Italy collected from April 2020 (wave 1) to May 2022 (wave 10) was used to examine trends and determinants of COVID-19 preventive behaviors (i.e., mask wearing, hand washing). RESULTS: With a total of 27,095 participants, 53.5% were female, and 15.9% were aged 18-24, 67.9% 25-64, and 16.3% 65+. The trends in adherence decreased over time except in wave 5 where a spike in adherence levels matched wave 1 levels and a surge in reported COVID-19 infections. In multivariable logistic regression models, worry about overloading the health system (OR = 1.26, 95%CI: 1.22-1.31), perceived risk to one's own health (OR = 1.13, 95%CI: 1.08-1.18) and others (OR = 1.16, 95%CI: 1.10-1.22), and trust in institutions (OR = 1.20, 95%CI: 1.12-1.26), traditional news media (OR = 1.05, 95%CI: 1.01-1.10), and health providers (OR = 1.31, 95%CI: 1.26-1.37) increased the likelihood of engaging in COVID-19 preventive behaviors. However, those with high trust in social media were less likely to follow prevention guidelines (OR = 0.78, 95%CI: 0.75-0.80). CONCLUSIONS: Psychosocial factors (risk perceptions, worry, and trust variables) were associated with adhering to COVID-19 prevention guidelines. Findings that high trust in social media was related to low adherence suggests more research is needed to understand how public health can improve health communications via social media, a popular information resource. KEY MESSAGES: • Health risk perceptions and worry about overloading the health system were associated with adhering to COVID-19 prevention guidelines. • Trust in social media was related to low adherence to COVID-19 prevention guidelines.