We found that 92.7% of respondents had a supportive attitude towards the NPI strategy for control of COVID-19. The time of the survey was in the winter vacation in China. All CSs were at home for the holidays, and they had the same access to information as the general population. A high prevalence of support indicates that the NPI strategy had been well publicized. About 5.5% of respondents reported that they disagreed with the NPI strategy. Compared with respondents who agreed with the NPI strategy, the respondents who disagreed tended to be male, have a low level of education and to suffer from depression. Studies have shown consistently that men express a lower level of concern towards health risks [17, 18]. This may be the reason why men had a lower supportive attitude than that of women in our study. Postgraduate students had a slightly higher supportive attitude about the NPI strategy than that of undergraduate students. Studies on Middle East respiratory syndrome (MERS)-related knowledge, preventive behaviors, and risk perception among nursing students during the MERS outbreak showed that senior nursing students and female students had a high perception and practice of measures to control MERS [19–21]. That study suggests that intelligence has a positive effect on perception of a health strategy.
It is worth noting that the psychological status of respondents was linked to a supportive perception of the NPI strategy. Depression was a negative influencing factor in supportive perception of the NPI strategy, whereas anxiety had a positive influence regardless of sex or level of education. This result may have been because people suffering from depression frequently lack interest in life [22]. The reasons why anxiety was related to a supportive attitude to the NPI strategy may have been because: (i) anxiety was caused by COVID-19; (ii) COVID-19 caused anxiety in these respondents. Few studies have focused on anxiety and attitudes toward intervention measures to control and prevent disease. This suggests that people have the moderate anxiety caused by public health emergencies can enhance their implementation of relevant control strategies..
The measure adopted by most respondents was avoidance of public places (94.8%), followed by use of a facemask (92.8%), avoidance of gatherings (91.2%) and washing hands frequently (86.9%). Compared with the other three measures, the prevalence of adoption of handwashing was relatively low. Implementation of this measure is related to sanitation facilities: in China, there are not enough facilities for outdoor handwashing. The inconvenience and difficulty of maintaining a NPI measure is a potential obstacle to its adoption. During the epidemic of influenza A (H1N1) in 2009, CSs and the general population had a low acceptance of NPI measures because they disrupted workplace and leisure activities [23, 24].
We found that 76.5% of respondents adopted all four NPI measures. Zottarelli and colleagues showed that in the influenza A (H1N1) epidemic in 2009, when evaluating CSs in the USA, 72.1% of the study cohort reported frequent hand-washing, yet only 10.7% avoided public gatherings [25]. In another study conducted in a USA public university, the proportion of students who took any self-protective measure against influenza A (H1N1) was 64.9% [9, 23]. Those results indicate that more CSs in China implement NPI measures than CSs in USA.
There was a positive correlation between supportive perception and adoption behaviors towards the NPI strategy during the COVID-19 epidemic (Table 4). People with a supportive attitude towards the NPI strategy indicated that they had a high perception of protection against and risk of COVID-19, so it is likely that they would be willing to adopt the measures. A study by Wang and colleagues on the factors that determine adoption of preventive behaviors during the influenza A (H7N9) epidemic revealed that a protective perception positively influenced an individual’s willingness to take recommended actions [26].
Being female, having a high level of education, and being anxious meant that you were likely to adopt the measures of the NPI strategy. Importantly, respondents who reported having anxiety had a 28% higher chance of adopting the measures than those who were not suffering from anxiety. This finding suggested that the anxiety in students may have been caused by COVID-19. These results echo those from a study on perceived risk, anxiety, and behavioral responses in the early phase of the influenza A (H1N1) epidemic in the Netherlands [10]. Depression may negatively influence adoption of NPI measures, which may because of depression made people less willingly to take action and more indifferent about safety.
Medical knowledge did not influence adoption of measures. Interestingly, respondents who did not have an exposure history to COVID-19 patients or epidemic areas had less of a supportive attitude and adoptive behaviors to the measures compared with the ones who had exposure history (Table 3, Table 4). This finding may have been due to two reasons. First, if respondents had been exposed but did not develop COVID-19, their risk perception will be reduced, which is also known as optimistic bias. Parry and colleagues showed that, compared with people who had food poisoning due to Salmonella species, people who had not experienced food poisoning due to Salmonella species perceived their personal risk from food poisoning to be lower 26. Second, may be our respondents had reduced anxiety about COVID-19. Bults and colleagues showed that anxiety decreased over time in the influenza A (H1N1) epidemic in 2009 [10].
Our study had two main limitations. First, it was a cross-sectional study and therefore weak in causation. Second, there may have been an information bias because the study data were time-sensitive and self-reported.
Our study had three main advantages. First, this survey was done shortly after the outbreak, which might indicate how the respondents would actually react where interferences were little. Second, we analyzed the impact on supportive perception and adoptive action towards the NPI strategy by the social demographics and psychological status of CSs, which has been studied scarcely previously. Third, this is the first study focusing on COVID-19-related supportive perception and adoption towards an NPI strategy. These results can provide: (i) insights for public health decision-makers; (ii) helpful information on the NPI measures people are willing to adopt (and the factors affecting adoption) during an emerging epidemic.