Predictors of adherence to public health instructions during the COVID-19 pandemic
Abstract
Importance
Identifying risk factors for adherence to public health instructions for the COVID-19 pandemic may be crucial for controlling the rate of transmission and the pandemic’s health and economic impacts.
Objective
To determine sociodemographic, health-related, risk-related, and instruction-related factors that predict non-adherence to instructions for the COVID-19 pandemic.
Design
Cross-sectional survey in Israel collected between March 28 and April 10, 2020.
Setting
Population-based study.
Participants
A convenience sample completed an online survey.
Exposures
Sociodemographic, health-related, risk-related, and instruction-related characteristics of the participants that have been linked to adherence to medical instructions.
Main Outcome and Measure
Non-adherence to instructions defined by a mean score of less than 4 on a 1 to 5 adherence scale consisting of 19 instruction items.
Results
Among 654 participants (413 [64.8%] female, age 40.14 [15.23] years), 28.7% were defined as non-adherents. Non-adherence was associated with male gender [adjusted odds ratio (aOR) = 1.54, CI 1.03– 2.31], not having children [aOR = 1.73, 1.13–2.65], smoking [aOR = 2.27, CI 1.42–3.62], high levels of ADHD symptoms [aOR = 1.55, CI 1.07–2.25], high levels of past risk-taking behavior [aOR = 1.41, CI 1.10–1.81], as well as by current high psychological distress [aOR = 1.51, CI 1.14–2.01], low perceived risk of COVID-19 [aOR = 1.52, CI 1.22–1.89], low exposure to the instructions [aOR = 1.45, CI 1.14–1.82], and low perceived efficacy of the instructions [aOR = 1.47, CI 1.16–1.85]. Adjusted OR of age, economic status, physical health status, and exposure to media did not reach the significance level.
Conclusions and Relevance
People with the above characteristics may have increased risk for non-adherence to public health instructions. There appears to be a need for setting out and communicating instructions to specifically targeted at-risk populations.
Key Points
Question
What factors are associated with non-adherence to public health instructions during COVID-19?
Findings
In a cross-sectional study of 654 Israeli participants, non-adherence to instructions was associated with male gender, not having children, smoking, high levels of attention-deficit/hyperactivity disorder (ADHD) symptoms, low level of pro-sociality, and high levels of past risk-taking behavior, as well as by current high psychological distress, high perceived risk of the COVID-19, high exposure to the instructions, and high perceived efficacy of the instructions.
Meaning
The findings suggest that in setting out and communicating public health instructions, policymakers should consider the above sociodemographic, health-related, risk-related, and instruction-related characteristics.
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