Compliance of the Public with Governmental Regulations and Recommended Protective Health Behavior During COVID-19: Lessons Learned from Varied Waves of the Pandemic in Israel

Abstract

Introduction:Managing pandemics is dependent on the adherence of civil societies to directives and recommendations issued by governmental and public health authorities. In the context of the COVID-19 pandemic, hurdles were encountered by authorities regarding public compliance to orders and recommendations of protective health behavior. The objective is to investigate the factors that most powerfully enhance or impede compliance to varied measures–both regulations (i.e. lockdown, mask wearing, social distancing) and recommendations (i.e. vaccination etc.) in Israel.Method:A longitudinal study, based on structured questionnaires was conducted to investigate factors that enhance or impede the uptake of protective health behavior throughout two years of COVID-19.Results:Various factors throughout different phases of the pandemic have been identified as playing a significant role in compliance. During the initial phases of the pandemic, the most salient factors for enhanced compliance to non-pharmaceutical interventions (lockdown) were concern for family or self-health, while deterrence played little role. During the fourth wave, findings indicated that pandemic fatigue had begun to have cascading effects on vaccination efforts. Particularly at this stage, trust in authorities and even threat perception components were incapable of predicting uptake, while perceived importance of the vaccine and its effectiveness positively and significantly predicted uptake. Throughout the pandemic, a negative correlation between levels of resilience and distress symptoms and a positive correlation between resilience and enhanced compliance were identified.Conclusion:Utilizing tools for empowering the population rather than instilling fear or other deterrence measures are more effective approaches to increase compliance with governmental directives. Furthermore, the results highlight the importance of adapting and adjusting risk communication efforts to accommodate specific concerns and hesitations demonstrated by distinct groups during an evolving pandemic. Public health officials and authorities need to engage the public in resilience building activities to promote compliance.