Adherence of those at low risk of disease to public health measures during the COVID-19 pandemic: A qualitative study

Abstract

Public health measures (PHMs) proactively and reactively reduce the spread of disease. While these measures target individual behaviour, they require broad adherence to be effective. Consequently, the World Health Organization issued a special appeal to young adults, a known non-adherent population, for increased adherence with COVID-19 guidelines. However, little is known about why these low-risk individuals do or do not adhere to PHMs. This study investigates why young adults in a low-risk setting adhered to PHMs implemented during the COVID-19 pandemic. A qualitative research approach was chosen to gain an in-depth understanding of participants’ thoughts and experiences related to PHM adherence. Semi-structured interviews were conducted in April-May 2021 with 30 young adults living in Prince Edward Island (PEI), the province with the lowest COVID-19 case rate in Canada at that time. Thematic analysis was used to create a codebook based on the Theoretical Domains Framework, which was then inductively modified. The analysis identified eight themes that explained the adherence of young adults: (1) clear, purpose-driven adherence rationale, (2) developing trust in the local leadership, (3) adapting to novel measures, (4) manageable disruption, (5) adhering to reduce anxiety, (6) collective duty towards one’s community, (7) moral culpability and (8) using caution rather than compliance. Together, these themes demonstrate that young adults adhered to PHMs because of their sense of connection to their community, public health leadership, and concerns over stigma. We further argue that clear guidelines and communication from public health officials during both periods of high and low COVID-19 cases facilitate adherence. These findings are important for mitigating future public health emergencies as they explain why young adults, an important segment of the population whose adherence is critical to the success of PHMs, follow PHMs. Further, these findings can inform public health officials and other stakeholders aiming to develop successful adherence strategies.

‘I’ve never been so stressed in my life’: a qualitative analysis of young adults’ lived experience amidst pandemic restrictions in Prince Edward Island, Canada

“…Such efforts may yield additional benefits as we demonstrated in previous work that focusing on community in public health guideline messaging can promote adherence among young adults. 38 Our findings also extend the conceptual work in the illness experience literature, given that, in some ways, the experiences of young adults in the pandemic resembled illness (eg, a state of suboptimal mental, physical and social well-being 39 ), even for those that did not contract the virus. For example, analogous to our theme of life Open access disruption, illness as a biographical disruption refers to the disarray that illness causes on one's daily activities, social fabric and narratives used to understand oneself and one's life trajectories.…”

The evolving epidemiology of SARS-CoV-2

“…15 Adherence to population level public health orders also cannot be assumed to be an endless commodity to call upon, especially among those who have been informed they are less at risk of severe illness or have experienced mild illness previously. 16 Non-pharmaceutical interventions also carry risk of other negative effects on health, healthcare access, population health and health inequalities, 17 and so the public health policy risk calculus supporting interventions shifts as the www.publish.csiro.au/ma Microbiology Australia risks associated with infection reduce with increasing population immunity, and treatment options expand and improve.…”