Predictors of changing patterns of adherence to containment measures during the early stage of COVID-19 pandemic: an international longitudinal study
Authors: Chong Yuen Yu , Chien Wai Tong , Cheng Ho Yu , Lamnisos Demetris , Ļubenko Jeļena , Presti Giovambattista , Squatrito Valeria , Constantinou Marios , Nicolaou Christiana , Papacostas Savvas , Aydin Gökçen , Ruiz Francisco J. , Garcia-Martin Maria B. , Obando-Posada Diana P. , Segura-Vargas Miguel A. , Vasiliou Vasilis S. , McHugh Louise , Höfer Stefan , Baban Adriana , Neto David Dias , da Silva Ana Nunes , Monestès Jean-Louis , Alvarez-Galvez Javier , Blarrina Marisa Paez , Montesinos Francisco , Salas Sonsoles Valdivia , Őri Dorottya , Kleszcz Bartosz , Lappalainen Raimo , Ivanović Iva , Gosar David , Dionne Frederick , Merwin Rhonda M. , Gloster Andrew T. , Kassianos Angelos P. , Karekla Maria 
Published: April 2023

Abstract
Background
Identifying common factors that affect public adherence to COVID-19 containment measures can directly inform the development of official public health communication strategies. The present international longitudinal study aimed to examine whether prosociality, together with other theoretically derived motivating factors (self-efficacy, perceived susceptibility and severity of COVID-19, perceived social support) predict the change in adherence to COVID-19 containment strategies.

Method
In wave 1 of data collection, adults from eight geographical regions completed online surveys beginning in April 2020, and wave 2 began in June and ended in September 2020. Hypothesized predictors included prosociality, self-efficacy in following COVID-19 containment measures, perceived susceptibility to COVID-19, perceived severity of COVID-19 and perceived social support. Baseline covariates included age, sex, history of COVID-19 infection and geographical regions. Participants who reported adhering to specific containment measures, including physical distancing, avoidance of non-essential travel and hand hygiene, were classified as adherence. The dependent variable was the category of adherence, which was constructed based on changes in adherence across the survey period and included four categories: non-adherence, less adherence, greater adherence and sustained adherence (which was designated as the reference category).

Results
In total, 2189 adult participants (82% female, 57.2% aged 31–59 years) from East Asia (217 [9.7%]), West Asia (246 [11.2%]), North and South America (131 [6.0%]), Northern Europe (600 [27.4%]), Western Europe (322 [14.7%]), Southern Europe (433 [19.8%]), Eastern Europe (148 [6.8%]) and other regions (96 [4.4%]) were analyzed. Adjusted multinomial logistic regression analyses showed that prosociality, self-efficacy, perceived susceptibility and severity of COVID-19 were significant factors affecting adherence. Participants with greater self-efficacy at wave 1 were less likely to become non-adherence at wave 2 by 26% (adjusted odds ratio [aOR], 0.74; 95% CI, 0.71 to 0.77; P < .001), while those with greater prosociality at wave 1 were less likely to become less adherence at wave 2 by 23% (aOR, 0.77; 95% CI, 0.75 to 0.79; P = .04).

Conclusions
This study provides evidence that in addition to emphasizing the potential severity of COVID-19 and the potential susceptibility to contact with the virus, fostering self-efficacy in following containment strategies and prosociality appears to be a viable public health education or communication strategy to combat COVID-19.