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

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 longitudinal
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 severity
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. Adjustedmultinomial 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.