Predictors of confidence and trust in government and institutions during the COVID-19 response in Australia

Abstract

Concern about misinformation and inattention to population health advice has highlighted the need to understand public confidence and trust in government and institutions during the COVID-19 pandemic. With the recent surge of the Omicron variant (BA.1) and its sub-variant (BA.2), primarily affecting younger people in Australia; alongside rapidly changing policies and advice surrounding booster vaccinations, testing, restrictions, isolation, and uncertainties around emerging variants this understanding is now more important than ever. Public confidence and trust in governments and institutions is particularly vital in understanding the persistent issue of vaccine hesitancy.1Kerr JR Schneider CR Recchia G et al.Correlates of intended COVID-19 vaccine acceptance across time and countries: results from a series of cross-sectional surveys.BMJ Open. 2021; 11e048025https://doi.org/10.1136/bmjopen-2020-048025Crossref Scopus (25) Google Scholar Although Australia has a highly vaccinated population, uptake of boosters (third dose) has been low2Melbourne institute: applied economic & social research. Vaccine hesitancy tracker. https://melbourneinstitute.unimelb.edu.au/publications/research-insights/ttpn/vaccination-reportGoogle Scholar and immunity to COVID-19 is waning. Previous reports have indicated that a lack of confidence and trust are fundamental drivers of vaccine hesitancy.3Khazan O. What's Really Behind Global Vaccine Hesitancy. The Atlantic, 2021Google Scholar This analysis explored correlates of confidence and trust in government and institutions during the COVID-19 response in Australia. In July-August 2021 in Australia as the Delta outbreak began to peak, we conducted a national survey of 2050 Australian adults aged 18–49 years. The sample characteristics were comparable to national estimates, with only slightly higher levels of education. At the time, this age group had been under-studied during the COVID-19 pandemic and vaccination roll-out in Australia in this age group had just begun, hence we only included those who had not yet received a COVID-19 vaccine. Along with a number of measures to understand barriers to COVID-19 vaccine uptake,4Pickles K Copp T Dodd RH et al.COVID-19 vaccine intentions in Australia.Lancet Infect Dis. 2021; 21: 1627-1628https://doi.org/10.1016/S1473-3099(21)00686-1Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar participants indicated their confidence (4-items) and trust (2-items) in government, and trust in institutions (scientists, researchers and medical institutions) (3-items) in managing the COVID-19 response, with items having a particular focus on vaccine development, distribution and information. Items were measured on a 7-point scale from previously published and validated measures,5Chow MYK Danchin M Willaby HW Pemberton S Leask J. Parental attitudes, beliefs, behaviours and concerns towards childhood vaccinations in Australia: a national online survey.Aust Fam Physician. 2017; 46: 145PubMed Google Scholar,6Frew PM Murden R Mehta CC et al.Development of a US trust measure to assess and monitor parental confidence in the vaccine system.Vaccine. 2019; 37: 325-332Crossref PubMed Scopus (17) Google Scholar with higher scores indicating higher confidence and trust (Appendix 1). Descriptive statistics were generated for sample characteristics and outcome measures. Pearson pairwise correlations were used to assess the association between confidence in government, trust in government, and trust in institutions. A multivariate regression model was constructed incorporating all three outcome measures with all sample characteristics (Appendix 2) as explanatory variables. We found that mean confidence in government was 4.52/7 (SD 1.41), mean trust in government was 4.36/7 (SD 1.66) and mean trust in institutions was 5.06/7 (SD 1.52; Appendix 2). There were strong positive associations between confidence in government and trust in government (r=0.699, p<.001) and trust in institutions (r=0.700, p<.001). Similarly, trust in institutions and trust in government were strongly correlated (r=0.694, p<.001). After adjusting for all other explanatory variables, lower confidence and trust were associated with older age, lower education, inadequate health literacy, being born in Australia, lower perceived COVID-19 risk in Australia, not being personally concerned about getting COVID-19, the use of non-official (government) information sources as a top information source and having one or more chronic health conditions. Confidence and trust differed as a function of residential state (Appendix 3). To our knowledge this is the first report examining factors associated with confidence and trust in government and institutions during the COVID-19 response amongst a nationally representative sample of younger adults; a group in which vaccine hesitancy has been at times disproportionately high in Australia.7Dodd RH Pickles K Cvejic E et al.Perceived public health threat a key factor for willingness to get the COVID-19 vaccine in Australia.Vaccine. 2021; https://doi.org/10.1016/j.vaccine.2021.08.007Crossref PubMed Scopus (10) Google Scholar Compared to an earlier evaluation from a sample of Australian adults aged 18-90 years using the same measures, mean confidence and trust in our sample of younger adults (18-49 years) was lower.8Pickles K Cvejic E Nickel B et al.COVID-19 misinformation trends in Australia: prospective longitudinal national survey.J Med Internet Res. 2021; 23: e23805https://doi.org/10.2196/23805Crossref PubMed Scopus (40) Google Scholar Interestingly, we specifically found that older participants in our sample (those aged 40-49 years) had lowest confidence and trust in the government and institutions. Similar to findings of those who are vaccine hesitant and endorse misinformation beliefs about COVID-19,8Pickles K Cvejic E Nickel B et al.COVID-19 misinformation trends in Australia: prospective longitudinal national survey.J Med Internet Res. 2021; 23: e23805https://doi.org/10.2196/23805Crossref PubMed Scopus (40) Google Scholar,9McCaffery KJ Dodd RH Cvejic E et al.Health literacy and disparities in COVID-19-related knowledge, attitudes, beliefs and behaviours in Australia.Public Health Res Pract. 2020; 30https://doi.org/10.17061/phrp30342012Crossref Google Scholar lower levels of confidence and trust were associated with lower levels of education, lower health literacy, those who perceive COVID-19 to be less of a risk to themselves and the country, and notably those who primarily view COVID-19 information from non-official (government) sources such as social media. This further emphasises the need to focus communication efforts and improve community engagement and positive interactions with the healthcare systems10Ozawa S Paina L Qiu M. Exploring pathways for building trust in vaccination and strengthening health system resilience.BMC Health Serv Res. 2016; 16: 639https://doi.org/10.1186/s12913-016-1867-7Crossref PubMed Scopus (38) Google Scholar in these cohorts. While differences in confidence and trust across states is understandable due to differing COVID-19 responses, it highlights the need for greater national consistency in how information is communicated to the public in order to have enhanced widespread reliance on government and institutions. Throughout the COVID-19 pandemic, having public confidence and trust has been vital to effectively implement public health measures. This analysis identifies important subgroups to consider, such as middle-aged Australians, those with lower education and health literacy, and those obtaining information from non-official sources, for targeted research and communication. This will enable better understanding of public trust and identify strategies for how it can be bolstered to support future public health responses. KP, EC, TC, RD, CB, HS, MS, GMK and KM were involved in study design and data collection. BN and EC conducted the data analysis. BN, EC, TC, RD, CB and KM were involved in data interpretation. BN led the writing of the manuscript with all author authors contributing to revising the manuscript and approving the final manuscript for publication. GM-K is a volunteer committee member of the Australian Skeptics Society. All other authors declare no competing interests. We thank the Australians who participated in this study.