11 Reasons People Adopt Health Behaviors During Pandemics
And how to increase compliance with these behaviors.
Posted Mar 21, 2020
At this moment, the world seems polarized. While some people are locking themselves in their homes with weeks of food and supplies, others are partying on beaches with their friends. Why do some people follow protective behaviors during pandemics, while others defy them?
Behaviors during the 2009 swine flu (H1N1) pandemic and the 2002 SARS pandemic may give us some clues. The more recent swine flu infected a whopping 20 percent of people around the world. The death rate was fairly low at an estimated 0.02%, ultimately leading to much less devastation than we anticipate from COVID-19. Meanwhile, the deadly SARS virus killed nearly 10 percent of those whom it infected, but was much less infectious than COVID-19, thereby making it much easier to contain and ultimately less devastating.
Despite the differences between the viruses, similar forms of protective behaviors were recommended, including preventative behaviors (e.g., washing hands, disinfecting surfaces, getting vaccinated), avoidant behaviors (e.g., avoiding crowded areas, complying with quarantines), and management behaviors (e.g., taking prescribed medications, seeing a doctor).
Bish and Michie (2010) conducted a review of 26 articles on the three types of protective behaviors during the prior pandemics, identifying 11 predictors of these health behaviors:
1. Being older... sometimes. Despite all the anecdotes of elderly people being out and about right now, the researchers found that people who were older were generally more likely to engage in protective behaviors. Their behaviors, however, may vary by culture and time. In Singapore and Hong Kong during the 2002 SARS pandemic, elderly individuals reported high engagement in preventative behaviors, possibly due to increased feelings of susceptibility to the illness.
However, later on, during the 2009 swine flu pandemic, adolescents and young people (age 18-24) were more likely than the elderly to engage in preventative behaviors, perhaps due to their greater self-efficacy. I would venture to guess that schooling could have also played a role. In some countries (e.g., Australia), no relationship was found between age and protective behaviors.
2. Being a woman. Across different nations (e.g., Hong Kong, Singapore, Australia, UK) and for both pandemics, women were more likely than men to engage in protective behaviors. The researchers suggest that the gender difference may be due to women’s greater views of their susceptibility.
3. Being educated. It may be of no surprise that generally, individuals who were more educated have a greater tendency to engage in protective behaviors during pandemics. That said, there were a few contrary findings. For example, in the U.S., people with lower levels of education were more willing to receive vaccinations against the swine flu (Quinn et al., 2009).
4. Being anxious. Although anxiety has many downsides, there are upsides to it as well. People who were more anxious were more likely to adopt protective health behaviors during pandemics.
5. Trusting authority. Trust of authority was an important factor. People who trusted their government’s message were more likely to comply with protective behaviors.
6. Believing that one is susceptible. The researchers also investigated whether the health belief model might apply in understanding people’s health behaviors during pandemics. According to the health belief model, whether or not a person engages in a health behavior can be predicted by 4 main factors:
- the perceived threat of the illness (including perceived susceptibility and perceived seriousness of the illness)
- the perceived benefits and barriers for the behavior
- a “cue to action,” or defining event that spurs a person into action.
Indeed, studies indicate that perceived susceptibility, or the belief that one is likely to get the illness, predicted protective behaviors.
7. Believing that the illness is serious. Perceived susceptibility and the perceived seriousness of the illness come together to form perceived threat. While perceived susceptibility refers to one’s belief that they can be infected, perceived seriousness refers to one’s belief about the consequences of getting the illness. Studies indicate that those who believed that SARS or the swine flu were serious were indeed more likely to engage in protective behaviors.
8. Believing in the benefits of the health behaviors. Unsurprisingly, people who believed in the efficacy of protective behaviors were more likely to carry them out.
9. Perceiving fewer costs of the health behaviors. Theoretically, people who perceive fewer barriers in the way of protective health behaviors should be more likely to carry them out. Bish and Michie (2010) found that the research in this area was scarce. However the few existing studies were in support of the theory. People who feared vaccines and medications were less willing to have the vaccine/medication (e.g. Quinn et al., 2009). At the moment, costs of social distancing and quarantines are especially salient and should inform us of who will or will not engage in these protective practices.
10. Greater self-efficacy. To carry out a health behavior, one must first feel that they are capable of doing so. Indeed, self-efficacy was linked to greater engagement in protective behaviors. In some studies, adolescents were found to have greater self-efficacy than adults, which explains why age is not always a straightforward predictor of protective behaviors.
11. A cue to action. Research indicates that people who experienced potential symptoms—their “cue to action”—were more likely to engage in protective behaviors. Unfortunately, with COVID-19, this “cue to action” is likely to come too late as a person who is experiencing his or her first symptoms may have already spread the virus to countless others.
In conclusion, those who are older (sometimes), female, educated, anxious, and trusting of authority figures are more likely to engage in protective behaviors during pandemics. In addition, the health belief model is well-supported by past research on behaviors during the swine flu and SARS pandemics.
With COVID-19, we cannot wait for the typical “cue to action” for health behaviors (i.e., the experience of possible symptoms, the diagnosis of a loved one). With this in mind, to encourage protective behaviors, government officials should widely publicize the high rates of COVID-19 infection in the region and emphasize that people of any age can be infected.
The government could also consider highlighting the consequences of the illness, although this may have a negative effect on individuals’ well-being in the absence of self-efficacy. Therefore, government officials should find a way to increase self-efficacy, perhaps by modeling protective behaviors and showing the public how to safely carry on with their lives with social distancing in place. Additionally, officials should emphasize the benefits of these behaviors and make these benefits as tangible and concrete as possible for the public.
Finally, officials should build trust by adopting a policy of honesty and transparency in their communications with the public. Currently, we can easily observe the effects of distrust in the many conspiracy theories forming around COVID-19.
Importantly, the researchers note that the health belief model largely fails to take into account the role of emotions. They suggest that relief from anxiety may be a large driving force behind our behaviors in the time of a pandemic.
While for some people, the drive for relief from anxiety results in an increase in protective behaviors, we are also seeing an increase in irrational and rather damaging behaviors, an area that is less studied. This drive for relief likely explains why many people have the insatiable urge to venture inside crowded warehouses to buy large amounts of toilet paper—hardly a protective behavior. In the future, both types of behaviors—rational and irrational—must be planned for.
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Bish, A., & Michie, S. (2010). Demographic and attitudinal determinants of protective behaviours during a pandemic: a review. British Journal of Health Psychology, 15, 797-824. doi: https://doi.org/10.1348/135910710X485826