key: cord-0820817-zjomh4hh
authors: Cristea, V.; Dub, T.; Luomala, O.; Sivela, J.
title: COVID-19 behavioural insights study: Preliminary findings from Finland, April-May, 2020
date: 2020-10-14
journal: nan
DOI: 10.1101/2020.10.11.20210724
sha: a8371e9b3bd084fe0de6a06b541f49ece4629264
doc_id: 820817
cord_uid: zjomh4hh

The COVID-19 monitoring behavioural insights study was conducted from April-May 2020 in Finland. Respondents reported feeling confident protecting themselves against COVID-19 infection. Worries shifted from overloading the health system (mean value 5.5 [95% CI: 5.4-5.6]) to mental health concerns (mean value 5.3 [95% CI 5.2-5.4]). Maintaining physical distancing from families and friends decreased by 7% and 6%. Respondents mostly agreed that if a vaccine would become available, they would get it. The decrease in acceptance of recommended measures needs further analysis, but current results provide evidence to support the response.

Previous studies have demonstrated that traditional media, social media and public health communication can influence knowledge, behaviour and perception of public health issues 1-2 and influence preparedness and protective behaviour . [3] [4] Communication strategies should follow best practices for public health and risk communication and tailor messages accordingly, to address risk perceptions, attitudes toward risk avoidance, fears, worries and trust in authority 5 , and provide evidence-informed responses to misinformation, to support rational, adaptive and protective behaviours 6 . In April 2020, the Finnish Institute for Health and Welfare (THL) initiated regular monitoring of the Finnish population's behaviour, knowledge, perception and trust regarding novel coronavirus disease . From April 7, 2020, we monitored these variables bi-weekly and shared findings with decision makers to help identify appropriate response measures, policies, interventions and communication strategies.

We used the COVID-19 Snapshot Monitoring (COSMO Standard): Monitoring knowledge, risk perceptions, preventive behaviours, and public trust in the current coronavirus outbreak -WHO standard protocol 7-8 to design a brief (approximately 10 minutes) online survey. Three iterative randomly-selected panels of approximately 1000 participants, representative of Finnish population in terms of age groups, gender and place of residence were invited to respond to items assessing risk perceptions, worries, fears, trust and information-seeking behaviour. We assessed risk perception as the perceived probability of contracting COVID-19, personal susceptibility and the expected severity of the disease using a 7 point Likert scale, from low to high, for which we calculated a mean value and 95% confidence intervals. Other question items addressed worries, trust in authorities, information-seeking and protective behaviours. Physical distancing behaviour was evaluated using closed questions with three possible responses: already done, planned or not planned at all. We used a 7 point Likert scale ranging from 1(disagree) to 7 (agree) to assess attitude towards a potential vaccine by asking participants how likely they would be to get vaccinated if a potential vaccine became available and . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted October 14, 2020. . https://doi.org/10.1101/2020.10.11.20210724 doi: medRxiv preprint recommended by Public Health authorities. We present preliminary findings of the first three rounds of data collection ( Figure) , 7-9 April (n= 1009), 24-28 April (n= 1032) and 8-11 May (n=1060).

Respondents' perception of their susceptibility to contracting COVID-19 was highest at the second time point, with a mean value of 3.8 (95% CI: 3.7-2.8). In the third round, perceived probability of contracting the disease and its perceived severity decreased to a mean of 3.4 (95% CI Throughout the whole study period, the coronavirus situation continued to worry and frighten Finnish respondents, but this appeared to be decreasing. In the first survey round, the leading worries were related to . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted October 14, 2020. 

We assessed differences between male and female respondents, in terms of risk perception, worries, trust and information seeking patterns. Throughout the whole study period, women responded perceiving themselves to be more susceptible to contracting the infection, more confident in being able to protect themselves from infection, . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted October 14, 2020. . https://doi.org/10.1101/2020.10.11.20210724 doi: medRxiv preprint 5. 3-5.5 ] between the first and third survey round. Overall, most participants were in favor of receiving immunisation (69%, n=2141), 26% (n=809) mildly disagreed or had no opinion while 5% (n=151) strongly disagreed with benefiting from immunisation. There was no statistical difference regarding likelihood of receiving the vaccine between genders, however, age significantly influenced likelihood of receiving immunisation: the older respondents were, the most likely they were to get immunisation provided a vaccine would be available. This difference was evidenced at all time points. During the third wave, mean likelihood of getting immunisation ranged from 4.7[95% CI: 4.7-5.0] among 18-29 years old respondents to 6.1 [5.9-6.2] in respondents aged 65 years old or more.

This study provides evidence for decision makers and communication activities by assessing risk perceptions, worries, fears, trust in authority and information-seeking behavior during the COVID-19 epidemic, and describing changing attitudes over time, as the public health crisis develops. Currently, there is limited information available on the complex interaction between epidemiology, media attention, pandemic control measures, risk perception and compliance with public health measures. 9-10 Despite the relatively high risk perception of a possible infection with COVID-19, a steady decrease in adherence to public health measures was reported. Most respondents believed they are not highly susceptible to COVID-19, and if contracted, the disease would not be severe. Trust remained stable over the study period with worries expressed in different areas.

Surprisingly, own infection or infection of a loved one did not seem to be the greatest concern; rather, fears and worries were consistently related to economic recession, increase in mental health concerns and the situation of small businesses. Across the whole study, information-seeking behaviour shifted from searching information multiple times a day to several times a week. Measures such as avoiding physical contact with friends and family seem to be losing acceptance among the participants, indicating that such measures are becoming more difficult to sustain.

Overall attitude towards a potential vaccine was favorable, with older respondents more inclined to receive immunisation when it would become available.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted October 14, 2020. . https://doi.org/10.1101/2020.10.11.20210724 doi: medRxiv preprint

As the COVID-19 epidemic evolves, it is important to understand the dynamics of risk perceptions, fears, misinformation and protective behaviours, identify which protective measures are employed, and what information is lacking. Based on continuing data collection and analysis, this tool makes it possible for authorities to react quickly to emerging misinformation or sudden increases in risk perceptions that could foment panic.

This study was funded by the Finnish Institute for Health and Welfare.

None to declare.

We would like to acknowledge numerous persons that contributed to developing of the COVID-19 Snapshot . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted October 14, 2020. . https://doi.org/10.1101/2020.10.11.20210724 doi: medRxiv preprint

Pandemic Public Health Paradox": Time Series Analysis of the 2009/10 Influenza A / H1N1 Epidemiology, Media Attention, Risk Perception and Public Reactions in 5 European Countries

Risk perception and information seeking behaviour during the 2009/10 influenza A(H1N1)pdm09 pandemic in Germany

Crisis and Emergency Risk Communication as an Integrative Model

A meta-analysis of the effectiveness of health belief model variables in predicting behavior

Risk communication as a core public health competence in infectious disease management: Development of the ECDC training curriculum and programme

The CDC Field Epidemiology Manual

COVID-19 Snapshot Monitoring (COSMO Standard): Monitoring knowledge, risk perceptions, preventive behaviours, and public trust in the current coronavirus outbreak -WHO standard protocol

Monitoring behavioural insights related to COVID-19. The Lancet

It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted October 14, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted October 14, 2020. . https://doi.org/10.1101/2020.10.11.20210724 doi: medRxiv preprint