ABSTRACT
Background Personal protective behaviours (PPBs) played a crucial role in limiting the spread of infection during the COVID-19 pandemic, yet adherence to these behaviours varied at population level. Understanding the factors influencing adherence to protective behaviours is important, as PPBs will be a critical part of the response in future pandemics. Using behavioural science, we investigated the influences on adherence to PPBs, focusing on face mask wearing, social distancing, and lateral flow testing (LFT). Methods Two online surveys, the first gathering data on mask wearing and social distancing, and the second on lateral flow testing, were conducted in July and August 2021 with a sample from England and Wales (N = 20,488 (survey 1) and N = 26,613 (survey 2)). The survey questions were designed based on the Capability, Opportunity, Motivation (COM-B) model of Behavior. Multivariate models were used to examine associations between identified influences and adoption of these protective behaviours. Results Most respondents reported wearing a face mask in public indoor places (88.5%) and maintaining a 1+ metre distance (86.8%) all or most of the time. After two doses of COVID-19 vaccine, social distancing decreased with 48.3% reporting meeting friends or family and 38.3% visiting indoor places more frequently. Motivation, Opportunity and Capability factors were significantly associated with increased odds of wearing a face covering and social distancing. Among individuals who indicated using an LFT (comprising 68% of the total sample), 50.4% reported engaging in routine testing. For those who had never used an LFT, the predominant reason cited was a perceived lack of necessity for testing (55.3%). Statistically significant associations were found between routine testing and accurate interpretation of test results across all LFT belief-based statements (p < 0.05). Conclusions Findings indicated high levels of adherence to face masks, social distancing, and lateral flow testing, even amid reduced restrictions and high vaccination rates. Utilising a behavioural science framework, factors related to capability, opportunity, and motivation were found to significantly influence the use of these protective behaviours. Our recommendations can inform public health intervention design and guide the selection of implementation strategies for public health emergencies preparedness.
Subject(s)
COVID-19ABSTRACT
Background. The COVID-19 pandemic disproportionately affected people living and working in UK care homes causing high mortality rates. Vaccinating staff members and residents is considered the most effective intervention to reduce infection and its transmission rates. However, uptake of the first dose of the COVID-19 vaccine in care homes was variable. We sought to investigate factors influencing uptake of COVID-19 vaccination in care home staff to inform strategies to increase vaccination uptake and inform future preparedness.Methods. Twenty care home staff including managerial and administrative staff, nurses, healthcare practitioners and support staff from nine care homes across England participated in semi-structured telephone interviews (March-June 2021) exploring attitudes towards the COVID-19 vaccine and factors influencing uptake. We used thematic analysis to generate themes which were subsequently deductively mapped to the Capability, Opportunity, Motivation-Behaviour (COM-B) model. The Behavioural Change Wheel (BCW) was used to identify potential intervention strategies to address identified influences.Results. Enablers to vaccine uptake included the willingness to protect care home residents, staff and family/friends from infection and the belief that vaccination provided a way back to normality (reflective motivation); convenience of vaccination and access to accurate information (physical opportunity); and a supporting social environment around them favouring vaccination (social opportunity). Barriers included fears about side-effects (automatic motivation); a lack of trust due to the quick release of the vaccine (reflective motivation); and feeling pressurised to accept vaccination if mandatory (automatic motivation).Conclusions We identified influences on COVID-19 vaccine uptake by care home staff that can inform the implementation of future vaccination programmes. Strategies likely to support uptake include information campaigns and facilitating communication between staff and managers to openly discuss concerns regarding possible vaccination side effects. Freedom of choice played an important role in the decision to be vaccinated suggesting that the decision to mandate vaccination may have unintended behavioural consequences.
Subject(s)
COVID-19 , InfectionsABSTRACT
Background: COVID-19 continues to pose a threat to public health. Booster vaccine programmes are critical to achieve population-level immunity. Stage theory models of health behaviour can help our understanding of vaccine decision-making in the context of perceived threats of COVID-19. Purpose: To use the Precaution Adoption Process Model (PAPM) to understand decision-making about the COVID-19 booster vaccine (CBV) in England. Methods: An online, cross-sectional survey informed by the PAPM, the extended Theory of Planned Behaviour and Health Belief Model administered to people over the age of 50 residing in England, UK in October 2021. A multivariate, multinomial logistic regression model was used to examine associations with the different stages of CBV decision-making. Results: Of the total 2,004 participants: 135 (6.7%) were unengaged with the CBV programme; 262 (13.1%) were undecided as to whether to have a CBV; 31 (1.5%) had decided not to have a CBV; 1,415 (70.6%) had decided to have a CBV; and 161 (8.0%) had already had their CBV. Being unengaged was positively associated with beliefs in their immune system to protect against COVID-19, being employed, and low household income; and negatively associated with CBV knowledge, a positive COVID-19 vaccine experience, subjective norms, anticipated regret of not having a CBV, and higher academic qualifications. Being undecided was positively associated with beliefs in their immune system and having previously received the Oxford/AstraZeneca (as opposed to Pfizer/BioNTech) vaccine; and negatively associated with CBV knowledge, positive attitudes regarding CBV, a positive COVID-19 vaccine experience, anticipated regret of not having a CBV, white British ethnicity, and living in East Midlands (vs. London). Conclusions: Public health interventions promoting CBV may improve uptake through tailored messaging directed towards the specific decision stage relating to having a COVID-19 booster.