Count on trust: the indirect effect of trust in government on policy compliance with health behavior instructions.

Trust in government is considered a prominent factor for enhancing public compliance with government policies and instructions. The Coronavirus pandemic demonstrates the crucial role public compliance with governmentally issued health guidelines has in mitigating the pandemic. However, the mechanism explaining the trust-compliance association, particularly in regard to health-behavior compliance, is unclear. This article develops a new theoretical model, the Mediated Trust Model (MTM), for explaining the relationship between trust in government and public compliance with health instructions. The model extends the classic Health Belief Model for predicting health behavior by claiming that the perceptions regarding the instructions' costs, benefits and one's ability to perform them are affected by trust in government and mediate the trust-compliance association. The MTM was tested in four cross-sectional studies performed during the first 20 months of the Coronavirus pandemic in Israel on 3732 participants, for various health instructions. Implications for public health literature, policy compliance theory and policy makers are discussed.

How to boost the boosters? A survey-experiment on the effectiveness of different policies aimed at enhancing acceptance of a "Seasonal" vaccination against COVID-19.

BACKGROUND: Evidence suggests a gradual decrease in the effectiveness of the anti-COVID-19 vaccines, stressing the potential need for periodical booster shots. However, it is hard to tell whether previously applied policies for enhancing vaccine acceptance will be as effective for repeated periodical booster shots during a pandemic. Hence, this study aims to explore the effectiveness of different health policies on periodical vaccination acceptance amidst an ongoing pandemic. METHODS: A cross sectional online experiment was performed in a representative sample of 929 Israeli citizens. Participants were randomly allocated to 4 groups simulating different hypothetical periodical-vaccination-promoting policy scenarios: (1) Mandate (N = 229); (2) a negative monetary incentive (N = 244); (3) a positive monetary incentive (N = 228) and (4) information provision (N = 228). Compliance intentions and vaccine-acceptance-related variables were measured. Analysis included multivariate hierarchic logistic and linear regressions. RESULTS: Compliance intentions levels were medium (M = 3.13 on a 1-5 scale). Only 20.2% of the sample demonstrated strong acceptance of periodical vaccination, which is lower than the acceptance rate of the seasonal flu shot in the country in the year preceding the pandemic. Type of policy was related to the extent to which a respondent strongly agreed to be periodically vaccinated or not. Specifically, strong acceptance was more likely when positive or negative incentives were presented in comparison to the mandate or information provision conditions. However, when examining the extent of compliance among respondents who were less decisive, the type of policy did not predict the extent to which these respondents intended to comply. In addition, compliance intentions were related with the perceived benefits and barriers of the vaccine, the perceived efficacy of getting vaccinated and social norms. Hesitator's intentions were additionally associated with anti-COVID-19 vaccination history, perceived severity of the disease and trust in government. CONCLUSIONS: Pandemic-containing vaccines may be perceived as less effective and beneficial than pandemic-preventing vaccines. Individuals with different levels of motivation for periodical vaccination during a pandemic may be affected by different factors. While strongly opinionated individuals are affected by the type of vaccination-promoting policy, hesitators are affected by a larger number of factors, which provide policy makers with greater opportunities to enhance their vaccination intentions.

Framing policies to mobilize citizens' behavior during a crisis: Examining the effects of positive and negative vaccination incentivizing policies

The COVID-19 pandemic has highlighted the issue of mobilization policies, that is, government practices directed at making the mass public voluntarily perform various behaviors for the collective benefit during a crisis. As COVID-19 vaccinations became accessible, governments faced the challenge of mass vaccination mobilization in order to achieve herd immunization. Aiming to effectively realize this goal, policy designers and regulators worldwide considered various mobilizing tools for vaccination compliance, including rewards and penalties, as they targeted vaccine opposers and hesitators, while trying to avoid the crowding-out effect among individuals who were intrinsically motivated to get vaccinated. However, the unique circumstances of the Coronavirus pandemic may have eliminated the crowding-out effect. Thus, our study explored the effect of regulation in the form of positive and negative incentivizing tools (i.e., rewards and penalties) during the coronavirus pandemic on vaccination intentions of 1184 Israeli citizens, prior to the national vaccination campaign. Results indicate that (1) both negative and positive incentives have a similar positive effect on individuals who declare they will not get vaccinated and those who hesitate to get the shot;(2) both positive and negative incentives induce the crowding-out effect;and (3) negative incentives generate a larger crowding-out effect in individuals who report preliminary intentions to get vaccinated, compared to positive ones. This emphasizes the need to avoid the crowding-out effect during the current and similar crises, and suggests considering applying a gradual and adaptive policy design in order to maximize regulatory efficacy and compliance.

"Apples and Oranges:" Examining Different Social Groups' Compliance With Government Health Instructions During the COVID-19 Pandemic.

BACKGROUND: The coronavirus outbreak has demonstrated the crucial effect of the public's compliance with the government's health instructions on the population's health. However, evidence shows that some communities are less likely to comply with such instructions than others. This study highlights the factors related to intentions to comply with newly issued health directives during an ongoing extreme crisis, such as the current pandemic. In addition, it compares the impact of these factors on different minority groups and the general population in Israel. METHODS: Using an online survey (N=1005), we examined the impact of compliance-related factors on compliance intentions with newly issued health directives in two minority groups in Israel: the ultra-Orthodox Jewish community (N=323) and the Arab community (N=361), as well as in the general population (N=321), during the first outbreak of coronavirus disease 2019 (COVID-19). Participants were presented with a new made-up COVID-19-related instruction simulated to be issued by the Israeli Ministry of Health. Compliance intentions and compliance-related factors were measured. RESULTS: The Arab minority expressed greater intentions of complying with the instructions than the other groups. Perceptions on risk and the effectiveness of the instruction were the only two significantly associated factors with compliance intentions in all of the social groups. Additional factors affected different groups to different extents. Trust in government was related to compliance intentions only in the Arab minority. CONCLUSION: Intentions to comply with health instructions during a crisis differ in various minority groups and in comparison to the general population, both in their levels and in the factors related to them. Policy-makers and health authorities should consider providing information about the risks and negative outcomes of the crisis as well as the expected effectiveness of the recommended behaviors. Future research should examine other minority groups and other types of instructions in different stages of a crisis.