key: cord-1012907-82635m5o
authors: Pförtner, Timo-Kolja; Hower, Kira Isabel
title: Educational inequalities in risk perception, perceived effectiveness, trust, and preventive behaviour in the onset of the COVID-19 pandemic in Germany
date: 2022-03-16
journal: Public Health
DOI: 10.1016/j.puhe.2022.02.021
sha: 3cac9e84b9577f1d305550c98bd6b2569a8d11e6
doc_id: 1012907
cord_uid: 82635m5o

Objectives This study analysed educational inequalities in risk perception, perceived effectiveness, trust, and adherence to preventive behaviours in the onset of the COVID-19 pandemic in Germany. Study design This was a cross-sectional online survey. Methods Data were obtained from the GESIS Panel Special Survey on the Coronavirus SARS-CoV-2 Outbreak in Germany including 2,949 participants. Stepwise linear regression was conducted to analyse educational inequalities in risk perception, perceived effectiveness, trust, and adherence to preventive behaviours considering age, gender, family status, and household size as covariates. Results We found lower levels in risk perception, trust towards scientists, and adherence to preventive behaviour among individuals with lower education, a lower level of trust towards general practitioners among individuals with higher education, and no (clear) educational inequalities in perceived effectiveness and trust towards local and governmental authorities. Conclusion The results underline the relevance of a comprehensive and strategic management in communicating the risks of the pandemic and the benefits of preventive health behaviours by politics and public health. Risk and benefit communication must be adapted to the different needs of social groups in order to overcome educational inequalities in risk perception, trust, and adherence to preventive behaviour.

Risk communication and adherence to preventive behaviour are core elements of the success of public health interventions to prevent and decrease the spread of infection diseases such as the Coronavirus disease 2019 . Since its official declaration as a pandemic in March 2020, Germany has undertaken different measures to prevent the spread of SARS-CoV-2 accompanied by the communication of risks of SARS-CoV-2. 1 The successful containment of the pandemic by appropriate preventive behaviours and a support of public health measures strongly depends on risk perception, perceived effectiveness of interventions, and trust towards individuals and institutions handling the pandemic. related studies suggest that individuals with low educational status show less COVID-19 preventive behaviours than others. [2] [3] [4] Moreover, single studies indicated lower risk perception, perceived effectiveness, and trust in the course of the COVID-19 pandemic among individuals with a lower educational status. 1, 3, 7, 8 This study builds on previous single studies and aims to analyse differences in risk perception, perceived effectiveness, trust towards different authorities, and adherence to preventive behaviours by educational status in the onset of the COVID-19 pandemic in Germany. In contrast to previous studies, this study allows a direct comparison of educational differences of factors important for the successful containment of the pandemic. The main research question is whether risk perception, perceived effectiveness, trust towards different authorities, and adherence to preventive behaviours differ by educational status, and whether an adaption of public health strategies in communicating the risks of the pandemic and benefits of preventive behaviour is required.

J o u r n a l P r e -p r o o f We used data from the GESIS Leibniz Institute for the Social Sciences panel´s subsample of online respondents the (n=3,186). Data for the present study were collected from 16 th to 29 th March 2020the onset of the pandemic in Germany -and included German-speaking individuals aged between 18 and 70 years. 9

Risk perception was measured by a sum score of 5 items. These capture the respondents' assessment of the likelihood that they or someone in their immediate environment would become infected with SARS-CoV-2, would need hospitalization due to a SARS-CoV-2 infection, would need to be in quarantine, or would infect other persons in the next 24 months (ranging from 0: "not at all likely" to 7: "absolutely likely") (Cronbachs alpha: 0.82).

Perceived effectiveness was measured by a sum score of 7 items that captured respondents' perceptions of effectiveness against policy measures taken to close public and private sector facilities, ban visits to facilities with vulnerable groups, and movement restrictions (ranging from: 0 "not effective at all" to 7: "very effective") (Cronbachs alpha: 0.87).

As part of the survey, respondents were asked whether and to what extent they trust different authorities handling with the COVID-19 pandemic (ranging from 0 "do not trust at all" to 4 "trust completely"): the general practitioner, local authorities (local health authority, municipal and city administration), governmental authorities (Robert Koch Institute, Federal Chancellor, Federal Government, Ministry of Health), and scientists.

Preventive behaviour based on a sum score of eight items on behaviour to decrease risks of a COVID-19-infection in the past 7 days (Cronbachs alpha: 0.52). Avoidance of certain places, maintaining a minimum distance, adjusting school and work situations, quarantine measures, more frequent and prolonged hand hygiene, use of disinfectants, stocking up on water and food, reduced personal contacts, wearing a face mask (response options: "No" and "Yes").

Educational level was measured using the ISCED-97 scale (12) and was recoded into three categories (low, intermediate, and high). Covariates were gender, age (ten 5-year-categories), marital status (unmarried, married or in partnership, widowed, and divorced) and household composition (one, two, or three or more persons).

We excluded participants with missing information on variables for any of the considered variables (n=2,949). Firstly, sample characteristics were described by percentages, mean levels, and standard deviations. Secondly, stepwise linear regression was conducted in which education (M1), age (as continuous variable) and gender (M2), family status (M3), and household size (M4) were successively included in the models. The degree of model fit was assessed with R 2 .

The study population included 51.2% men and 48.8% women. The proportions of age groups ranged from 2.3% (aged lower than 25 years) to 26.7% (aged 51 to 65 years). 66.3% of the respondents were married, 22.2% unmarried, 7.7% divorced, and 3.7% widowed. 48.5% lived in a two-person household, 40.3 % in a household with three or more household members, and 11.2% in a single In the regression analyses, some of the sociodemographic factors were related to the outcomes considered (see supplementary Tables S1 to S7). Older individuals were significantly more likely to report lower risk perception and prevention behaviours, but consistently had higher trust scores.

Women were significantly more likely than men to perceive containment measures as effective and to report higher levels of trust in local and government authorities and to engage in prevention behaviours. Finally, singles, in contrast to married individuals, had significantly lower risk perceptions, lower perceived effectiveness, and lower trust in local authorities and prevention behaviours. In addition to educational status, the associations found were particularly strong for age and gender.

We found lower levels in risk perception, trust towards scientists, and adherence to preventive The finding of significant associations of educational status with risk perception, trust towards scientist, and adherence to preventive behaviour complies with other studies. 1,3,10 However, as this study was conducted in the onset of the pandemic in Germany, associations might have changed over time as shown in the study of Rattay et al. 1 Moreover, lower education was associated with lower levels of trust towards scientist, which might be explained by a lower scientific knowledge of lower educated individuals and an inadequate communication of scientific evidence to lower educated individuals. 11 We found higher levels of trust towards general practitioners among lower educated individuals as found in a study among U.S. cancer patients. 12 This might be explained by a generally higher tendency of people with a lower education to not question the medical profession´s actions. Finally, perceived effectiveness of containment measures was generally at a higher level and did not significantly vary by educational status, which undermines the general trust towards the efficacy of local and governmental measures in terms of COVID-19. Moreover, age, gender and family were significantly related to risk perception, perceived effectiveness, trust, and adherence to preventive behaviours, which is in line with previous studies. 1, 3, 4, 7, 8 In order to reach individuals with a low educational status as well as other social groups, planned risk management by leadership in times of pandemic is necessary. 13

It is an asset that we used data from a representative population-based survey conducted at the onset of the COVID-19 pandemic. One limitation of this study is the lack of information on pandemic knowledge that might strongly interrelate with risk perception, perceived effectiveness, and adherence to preventive behaviour. As the survey was conducted at the onset of the pandemic and cross-sectionally, we were not able to analyse how appraisals might have changed over the course of the pandemic. Moreover, the interpretation of the results and the level of disparities found by educational status may be influenced by the scaling of the outcome variables as well as by the different response categories of the raw items of the respective outcomes. Scaling the variables to an index from zero to 100 allows for a comparison of coefficients across the outcome variables, but J o u r n a l P r e -p r o o f 

Differences in risk perception, knowledge and protective behaviour regarding COVID-19 by education level among women and men in Germany. Results from the COVID-19 Snapshot Monitoring (COSMO) study

Determinants of Preventive Behaviors in Response to the COVID-19 Pandemic in France: Comparing the Sociocultural, Psychosocial, and Social Cognitive Explanations

Protective Behavior in Course of the COVID-19 Outbreak-Survey Results from Germany

Acceptance and adoption of protective measures during the COVID-19 pandemic: The role of trust in politics and trust in science

Risk communication for public health emergencies

Risk Communication in the Age of COVID-19

Perceived Trust in Public Authorities Nine Months after the COVID-19 Outbreak: A Cross-National Study

Public perspectives on protective measures during the COVID-19 pandemic in the Netherlands, Germany and Italy: A survey study

Knowledge, attitudes, and practices (KAP) toward COVID-19: a crosssectional study in South Korea

Science understanding between scientific literacy and trust: contributions from psychological and educational research

Lower Levels of Trust in the Medical Profession Among White, Younger, and More-educated Individuals with Cancer

Recalibrating pandemic risk leadership: Thirteen crisis ready strategies for COVID-19

Notes: M1: bivariate model; M2: M1+age & sex

Abbreviation: CI=Confidence Interval