Measuring Italian Citizens’ Engagement in the First Wave of the COVID-19 Pandemic Containment Measures: A Cross-sectional Study

Abstract

Background: In January 2020, the coronavirus disease 2019 (COVID-19) started to spread in Italy. The Italian government adopted urgent measures to hold its spread. Enforcing compliance to such measures is crucial in order to enhance their effectiveness. Engaging citizens′ in the COVID-19 preventive process is today urgent in Italy and around the world. However, to the best of our knowledge, no previous studies have investigated the role of health engagement in predicting citizens compliance to health emergency containment measures. Method: An online survey was administered between February 28th and March 4th 2020 on a representative sample of 1000 Italians. The questionnaire included a measure of Health Engagement (PHE-S) and a series of ad hoc items intended to measure both affective and behavioral responses of the citizens to the emergency in terms of perceived susceptibility to and severity of the disease, orientation towards health management, change in habits and in purchases. To investigate the relationship between Health Engagement and these variables, a series of ANOVAs, Logistic regressions and crosstabs have been carried out. Results: Less engaged people show higher levels of perceived susceptibility to the virus and of severity of the disease; they trust less scientific and healthcare authorities, they feel less self-effective in managing their own health - both in normal conditions and under stress - and are less prone to cooperate with healthcare professionals. Low levels of Health Engagement are also associated with a change in the usual purchase behavior. Conclusions: The Patient Health Engagement Model (PHE) provides a useful framework for understanding how people will respond to health threats such as pandemics. Therefore, intervention studies should focus on particular groups and on raising their levels of engagement to increase the effectiveness of educational initiatives devoted to promote preventive behaviors.

“#I-Am-Engaged”: Conceptualization and First Implementation of a Multi-Actor Participatory, Co-designed Social Media Campaign to Raise Italians Citizens’ Engagement in Preventing the Spread of COVID-19 Virus

“…According to this principle, a crucial step for the development of our campaign was the survey of a representative sample of the Italian population during the first phase of the emergency, which aimed at exploring people's literacy, attitudes, and levels of engagement toward COVID-19 prevention. The survey, which is discussed in more detail in another paper (Graffigna et al, 2020), confirmed the opportunity to change of people's attitudes toward prevention, rather than only to increase their literacy. Furthermore, it demonstrated the role of engagement in improving people's attitudes toward preventive measures during the COVID-19 emergency.…”

“…After recruitment and informed consent, responders were asked to complete an online survey involving questions about health engagement, affective response, and behavioral responses to the COVID-19 pandemic. The full methodological details and results of this survey are reported in an extensive paper currently being submitted (Graffigna et al, 2020).…”

“…In the case of the COVID19 emergency, the risk of contagion from Sars-Cov-2 is-at the psychological level-an analog critical health event that can trigger the psychological ability of individuals (patients and not) to cope with risk and to engage in changes to health behavior. To prove this concept in relation to the recent COVID-19 pandemic, a high level of PHE is predictive of a safer adaptation to the emergency, considering different targets of the general population, such as adults and students (Graffigna et al, 2020;Nania et al, 2020).…”

Issues to be considered when planning sero-epidemiological studies in regions with a low incidence of SARS-CoV-2

“…3 In contrast, one-time cross-sectional investigation is tailored for the regions and countries with initial or subsequent peaks of transmission of epidemic waves (ie, Italy, Spain, and Wuhan). [3][4][5] The second issue is population selection. For regions with a low incidence of SARS-CoV-2, targeting specific population groups should be taken into account.…”

“…In the United States of America, symptom-based (at least 10 days have passed since symptoms first appeared) and test-based strategies (negative results for SARS-CoV-2 detections from at least 2 consecutive respiratory specimens collected ≥24 hours apart) are proposed by the Centers for Disease Control and Prevention as the Return-to-Work criteria. 4 In Canada, health authorities justified allowing COVID-19 positive HCWs to return to work 10 days from the start of them having symptoms. 5 In Germany, home quarantine periods are recommended 14 days after being tested negative or without respiratory symptoms; in the case of staff shortages, the criteria of minimum 48 hours without symptoms and with 2 consecutive negative testing are applied.…”