Effects of trust, risk perception, and health behavior on COVID-19 disease burden: Evidence from a multi-state US survey

Abstract

Early public health strategies to prevent the spread of COVID-19 in the United States relied on non-pharmaceutical interventions (NPIs) as vaccines and therapeutic treatments were not yet available. Implementation of NPIs, primarily social distancing and mask wearing, varied widely between communities within the US due to variable government mandates, as well as differences in attitudes and opinions. To understand the interplay of trust, risk perception, behavioral intention, and disease burden, we developed a survey instrument to study attitudes concerning COVID-19 and pandemic behavioral change in three states: Idaho, Texas, and Vermont. We designed our survey (n = 1034) to detect whether these relationships were significantly different in rural populations. The best fitting structural equation models show that trust indirectly affects protective pandemic behaviors via health and economic risk perception. We explore two different variations of this social cognitive model: the first assumes behavioral intention affects future disease burden while the second assumes that observed disease burden affects behavioral intention. In our models we include several exogenous variables to control for demographic and geographic effects. Notably, political ideology is the only exogenous variable which significantly affects all aspects of the social cognitive model (trust, risk perception, and behavioral intention). While there is a direct negative effect associated with rurality on disease burden, likely due to the protective effect of low population density in the early pandemic waves, we found a marginally significant, positive, indirect effect of rurality on disease burden via decreased trust (p = 0.095). This trust deficit creates additional vulnerabilities to COVID-19 in rural communities which also have reduced healthcare capacity. Increasing trust by methods such as in-group messaging could potentially remove some of the disparities inferred by our models and increase NPI effectiveness.

Infection preventive behaviors and its association with perceived threat and perceived social factors during the COVID-19 pandemic in South Korea: 2020 community health survey

“…As early reports noted that the concerns and trust in health professionals, which affected preventive behaviors, tended to be lower in rural areas compared to urban ones, it is important to study the level of COVID-19 perception among regions and adherence to prevention rules [ 29 ]. Another study stated that in rural areas, the lower the trust in government policy, the lower were residents’ infection preventive behaviors [ 30 ]. Therefore, this study was conducted to identify what factors affect individuals’ health behaviors in preventing COVID-19 and whether these differ in distinct regions.…”

Social divisions and risk perception can drive divergent epidemic dynamics and large second and third waves

“…We demonstrate that the finding in Figure 1 applies across alternative scenarios where the pathogen is introduced in both groups at the same prevalence, but the groups differ in their transmission coefficients (ߚ), infection fatality rates (ߤ), or infectious period ( ଵ ఘ ) (Supplementary Figures 4,5,6). Note that, when transmission coefficient (ߚ) varies between groups, contacts between group a and group b will have transmission coefficient ඥߚ ߚ , the geometric mean of the transmission coefficient of both groups.…”

“…In fact, if self-protection is associated with significant costs, already-vulnerable populations may suffer compounding costs as they balance selfprotection against significant disease risk without adequate support from a broader community that does not share their risks (52)(53)(54)(55). Further, structural inequities often leave population subgroups that are vulnerable to larger, more severe outbreaks with reduced access to protective measures like health education, treatment, vaccination, and paid leave (5,20,46,48,(56)(57)(58)(59)(60). Resulting differences in rates of protective behavior uptake and effectiveness can compound disparities between groups and reduce the protective impact of awareness separation for more-vulnerable groups.…”

“…When an infectious disease causes substantial disease burden and death, people may respond to the true or perceived risk of infection by modifying their behavior (1–5). In turn, protective behaviors like physical distancing, mask wearing, and vaccination may suppress transmission, reducing peak and total infections and disease-linked mortality (3, 6, 7).…”

Social divisions and risk perception drive divergent epidemics and large later waves

“…When an infectious disease causes substantial disease burden and death, people may perceive their risk of infection based on their awareness of the magnitude of disease-linked outcomes and respond by modifying their behaviour (An et al, 2020; Cheok et al, 2021; Gidengil et al, 2012; Ridenhour et al, 2022; Yan et al, 2021). In turn, protective behaviours like physical distancing, mask wearing and vaccination may suppress transmission, reducing peak and total infections and disease-linked mortality (Abaluck et al, 2022; Toor et al, 2021; Yan et al, 2021).…”