Abstract
Non-pharmaceutical interventions (NPIs) represent the primary mitigation strategy for the COVID-19 pandemic. Despite this, many government agencies and members of the general public may be resistant to NPI adoption. We sought to understand public attitudes and beliefs regarding various NPIs and self-reported adoption of NPIs, and to explore associations between NPI performance and the baseline characteristics of respondents. We performed a cross-sectional age-, sex-, and race- stratified survey of the general US population. Of the 1,005 respondents, 37% (95% CI 34.0, 39.9) felt that NPIs were inconvenient, while only 0.9% (95% CI 0.3, 1.5) of respondents believed that NPIs would not reduce their personal risk of illness. Respondents were most uncertain regarding the efficacy of mask and eye protection use, with 30.6 and 22.1%, respectively, unsure whether their use would slow disease spread. On univariate logistic regression analyses, NPI adherence was associated with a belief that NPIs would reduce personal risk of developing COVID-19 [OR 3.06, 95% CI [1.25, 7.48], p = 0.014] and with a belief that NPIs were not difficult to perform [OR 1.79, 95% CI [1.38, 2.31], p < 0.0001]. Respondents were compliant with straightforward, familiar, and heavily-encouraged NPI recommendations such as hand-washing; more onerous approaches, such as avoiding face touching, disinfecting surfaces, and wearing masks or goggles, were performed less frequently. NPI non-adherence is associated with both outcome expectations (belief that NPIs are effective) and process expectations (belief that NPIs are not overly inconvenient); these findings have important implications for designing public health outreach efforts, where the feasibility, as well as the effectiveness, of NPIs should be stressed.
Highlights
Non-pharmaceutical interventions (NPIs) have emerged as a first line of protection and mitigation in the face of the Severe Acute Respiratory Syndrome (SARS)-CoV2 infection pandemic, given the evidence suggesting the efficacy of such interventions in previous pandemics [1, 2]
Most respondents stated that they were performing key NPIs, such as hand washing and social distancing, on a consistent basis, and the majority of respondents agreed that NPIs are effective in slowing the spread of COVID-19
Mask wearing and eye protection adherence and perceived efficacy lag behind other NPIs; this may be due to messaging, since at the time the survey was performed no recommendations were in place to encourage mask or face protection by the general public in the US
Summary
Non-pharmaceutical interventions (NPIs) have emerged as a first line of protection and mitigation in the face of the SARS-CoV2 infection pandemic, given the evidence suggesting the efficacy of such interventions in previous pandemics [1, 2]. Since modern NPIs were adopted over a century ago during the 1918–1919 flu pandemic, much of the public debate has remained unchanged, centering on the efficacy and burdensomeness of NPIs, and their potential for broader effects on morale and economic stability [3, 4]. Some have suggested that NPI adherence is improved with improved communication; that is, NPI non-adherence is the result of a knowledge gap [17,18,19,20,21,22,23,24,25]. Data from behavioral research suggests that non-compliance with expert recommendations is sometimes not a result of a lack of knowledge per se [26,27,28,29,30,31]
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