It is encouraging that most participants reported adhering to the main preventive behaviours recommended by the public health authorities. However, it is concerning that men throughout the age ranges were less likely to adopt the recommended measures than women, and this applied to all four preventive approaches. Young people were less likely to adopt preventive approaches than those aged 30 years or more, which was related in part to lower perceived susceptibility to a severe COVID-19 illness.
The SARS-CoV-2 incidence rate has remained relatively low in Hungary probably due to forthright decisions to implement broadly-based public health approaches at an early stage. These include measures aimed at spatial distancing and adopting hygienic approaches that were introduced at an early stage of the pandemic. Based on our results, a large proportion of the population adhered to the recommendation of avoiding close contacts and personal hygienic behaviours to control viral transmission. However, not all behaviours were followed equally: using face masks and protective gloves were less common and more variable among people who were inclined to follow all the other protective measures.
In our study, nearly 18% of the sample was identified as non-adherent or have limited adherence to the public health recommendations. Non-adherence rates in lifestyle-related behaviour change advice are around 30% (19). The non-adherence rates reported in the present study are therefore lower but are more concerning because of the implications for imminent morbidity and mortality. Nearly 20% of persons in the present study reported a low level of adherence to spatial distancing, face mask use and/or taking personal hygienic precautious, thus they have an increased risk of contracting and transmitting the SARS-CoV-2 virus and other respiratory infections in the future. At the time when countries try to relax the tight control over virus transmission, it becomes even more important to know the proportion of non-adherent individuals and the predictors of response to preventive advice.
Several countries have experienced higher rates of severe COVID-19 illness and deaths among men compared with women(11, 12, 20). This should be compared with the data from the present study of male gender being another important predictor of non-adherence. An increased risk of death among males was documented in relation to the previous SARS-virus induced acute respiratory syndrome, in which males had 66% higher risk of dying than females(21). Several hypotheses have been proposed to explain this gender difference, including different rates of smoking(22, 23). Our data highlight the gender difference in adherence to preventive behaviours. Since we do not have data about the smoking status of our participants we cannot control for the covariance between smoking and non-adherent behaviours. Previous studies also supported the gender disparities in handwashing behaviour and knowledge regarding personal hygienic behaviours(24, 25). However further research is necessary to disentangle the multiple behavioural mechanisms that can explain why males seem to be more vulnerable to respiratory infections. We also need research on the gendered meaning of preventive behaviours that would explain the lower rate of preventive behaviours among men(26).
Being of a younger age is an important predictor of non-adherence to preventive behaviours. Frequent communication regarding the SARS-CoV-2 virus stressed the fact that COVID-19 threatens mainly the older population. This can lead to a false safety message to younger people(27), though 1% of hospitalization due to COVID-19 in China was among those aged 20–29 years, and 3% from the age group of 30–39 years old(28).
Our study demonstrated different rates of preventive behaviours. The variance of the use of physical barriers may be due to several factors including (1) the lack of practice of face mask use; (2) the social meaning of face masks and gloves in Europe; and (3) messages from the WHO and the country’s officials regarding the use of face masks and protective gloves (WHO, 2020). However, previous experience with prevention of influenza emphasized the use of face mask with hand hygienic measures (8). It is important to note that face mask use did not decrease the frequency of the use of other preventive techniques, therefore it did not increase illusory safety. It can be recommended without the serious side effect of neglecting other infection control means. Furthermore, recent evidence supports the idea that face mask can protect from the transmission of viral RNA (29).
Our study is not without limitations. The cross-sectional design does not allow definitive conclusions about causation, and self-reported data may be distorted by social desirability bias. An independent direct observational study could validate our findings. However, in the present pandemic there is a compelling need for timeliness of studies. Understanding adherence to public health recommendations will help decreasing the likelihood of SARS-CoV-2 transmission and potentially the severity of the COVID-19 illness, and should help us in the future to prevent and contain influenza and other still unknown viral pandemics. Everyone, irrespective of their particular risk of these infections, can contribute to the health of the community as a whole. The findings from the present study emphasize that developing ways of engaging men, young people and those of low socioeconomic status in adopting preventive behaviours and emphasising the severity of the illness is vital not only for optimal prevention of SARS-CoV-2 transmission now and in the future, but also for effective control of related respiratory infections.