This study found a vast majority of the public knew relevant preventive measures during the period of COVID-19 outbreak in China and most of them adopt preventive behavior according to the advices. Those who were female, young and middle age, had high education attainment and better annual household income were more likely to perceive benefits of the social restriction measures and feel anxiety during the epidemic of COVID-19. Likewise, female, the respondents with better household income and those having good knowledge on preventive measures were more likely to adopt behaviors advised in response to the epidemic of COVID-19. Individual beliefs on benefits of the social restriction measures were also positively associated with the behavioral adoption.
There are a wide array of factors that influence the public behavioral adoption in response to the pandemic of emerging infectious diseases including the government responses, media’s portrayal and social culture and values. Compared to the previous studies on the public behavior in response to Severe Acute Respiratory Syndrome (SRAS), H1N1 and MERS epidemic in Hong Kong and other countries,[11–12, 18–19] our study found behavioral adoption of prevent person-to-person transmission of COVID-19 among the public in Chinese mainland was relatively high. The outbreak of COVID-19 in China occurred around the time of the lunar new year often with massive population travels. When Wuhan city, a center of the epidemic was locked down, number of reported cases increased rapidly and spread nationwide. All Chinese mainland provincial governments launched the highest level of response to the emergent public health event including closure of schools, public services, retail business and restaurants as well as constraints of individual movement and social interactions. The official public media, various social media and community-based approaches widely disseminated the COVID-19 related information and health education. The awareness of the disease severity and benefits of the social restriction measures among the public were high during the lock-down period in China. That is also the period the survey carried out. The study in the Netherland investigated the public response to H1N1 at several time points and found the level of knowledge on H1N1 prevention increased over time, while perceived severity, perceived self-efficacy, and intention to comply with preventive measures decreased. Given a high risk of the repeated epidemic of COVID-19, it will be critical to understand the change of attitudes and behavior response to the epidemic of COVID-19 over time to inform strategy sequencing.
This study also suggested that personal protective behaviors, such as wear of face mask when going out, more frequent hand wash and other personal and family hygiene habit were more likely to be widely adopted than social distancing behaviors, which is consistent with findings in other studies.[12, 20] In response to the 2009 influenza A H1N1 pandemic, the previous study proposed to combine efforts from both non-pharmaceutical interventions and vaccination program to achieve better preventive effects. When the vaccine against COVID-19 is not available, approaches adapted to local culture and social value to promoting non-pharmaceutical interventions, particularly social distancing behaviors will be effective to mitigate the burden of COVID-19 in various settings.
Consistent with the other studies on the public responses to emerging infectious diseases,[21–23] we found female and those having better household income and good preventive knowledge were more likely to behave according to health advices. In our study, they were also more likely to perceive the benefits of social restriction measures, which was positively associated with the behavioral adoption. The households with low income may face financial pressure and/ or difficulty due to loss of income or work opportunity during the lock-down period. This vulnerable group may be at a high risk of infection given poor behavioral adoption, even fall in poverty because of the illness. Hence, targeted health policy and other related public policy should pay attention on social vulnerable groups to improve equity in health.
In this study, we found that the people who did not feel anxiety during the epidemic were more likely to adopt the behavior advised that those who feel anxiety. The studies on public psychological behavior responses to SARS in Hong Kong and H1N1 in the Netherland found that moderate level of anxiety were positively associated with adopting preventive behaviors.[24–26] We did not measure the level of anxiety in this study. Our study suggests that psychological support for the public during the epidemic of emerging infectious diseases is highly important to guide release of negative emotions and improve healthy behavior.
This study captured the public responses to the pandemic of COVID-19 in China during the most lock-down period and has significant implications for relevant strategies and policies sequencing. There are also several limitations bearing in mind. Due to various constraints during the study period, we used snow-ball sampling methods through the social network of the research team. Despite we received the responses from 31 mainland provinces, the most respondents were from Chongqing municipality where the research team located. In addition, the link of the online survey was distributed through social media. Those who are not able to access to social media due to user unfriendly (e.g. the elders) or infrastructure limitations cannot be reached. Thus, the representation of the respondents may be biased and the generation of the results should be made with caution.