Exploring influencing factors on the adoption of nonpharmaceutical interventions during pandemics: COVID-19 as an example

Abstract

Background: Pandemics are associated with loss of life, hospitalizations, and disruption to people’s social and economic lives. As the 2019 pandemic illustrates, COVID-19 can be prevented by pharmaceutical and non-pharmaceutical interventions (NPIs). Recommended measures such as wearing a mask, washing hands, social distancing, and self-quarantine have been proven to curb the spread of the coronavirus. Identifying the factors associated with adherence to NPIs is the first step in understanding which levers of change to pull when designing health promotion interventions such as health communication campaigns. This dissertation explores these factors and proposes a health communication framework during pandemics. Research Questions: This dissertation has three research questions: 1) What demographic, personal-cognitive, and socio-environmental factors influenced the adoption of non-pharmaceutical interventions during pandemics among health care university students? 2) Which psychological, cognitive, or socio-environmental factors are more predictive of adherence to COVID-19 NPIs among the Saudi population? 3) What risk communication framework best suits public health messaging and communication to promote adopting non-pharmaceutical interventions during a pandemic? Methods: In the first manuscript, a systematic review was conducted to identify demographic, personal-cognitive, and socio-environmental factors influencing the adoption of non-pharmaceutical interventions during a pandemic among health care university students. In the second manuscript, a quantitative non-experimental survey research design study was conducted, where a Social Cognitive Theory-guided survey was used to measure adherence to non-pharmaceutical interventions and explore the personal cognitive and socio-environmental influencing factors. The third manuscript uses a grounded theory technique to explore the relevant literature on NPIs communication and develops a conceptual framework to assist the health communicator during pandemics. Results: In manuscript 1, the systematic review identified 18 articles for full-text review. The results yielded 18 demographic factors associated with NPIs practice factors, of which being older, female, observing others practice NPIs, and having higher risk perception levels were influencing factors. Additionally, cues to action, source of information, anger, confusion, and positive attitude, perceived stress, susceptibility, benefits, barriers, and severity influenced NPIs adherence. In manuscript 2, NPIs were strongly correlated with normative beliefs and negatively correlated with self-efficacy. The hierarchical multiple regression model revealed that socio-environmental factors explained a significant proportion of variance in NPIs (52%). In manuscript 3, the Pandemic Behavioral Prevention Framework was developed based on components adopted from the CDC’s Crisis and Emergency Risk Communication Model, The Social Amplification of Risk Perception Framework, and The Social Cognitive Theory. Conclusion: The dissertation’s manuscripts found that demographic factors such as age and gender, personal cognitive factors such as risk perception, and socioenvironmental factors like social norms are influential when deciding to practice NPIs. These factors can be the basis of any health promotion intervention to promote NPIs in future pandemics. Also, we developed the Pandemic Behavioral Prevention Framework to utilize the currently used models of communication, risk, and behavior in shaping effective NPIs communication during pandemics.