Perceptions and responses to COVID-19 through wastewater surveillance information and online search behavior: A randomized controlled trial

Abstract

Wastewater surveillance is anticipated to be a representative and timely method to assess infectious disease status; however, its influence on public perception and behavior remains unclear. Therefore, in this study, we used a randomized controlled trial to analyze the influence of wastewater surveillance-based information on understanding of, interest in, relief regarding, preventive behavioral intention against, and subsequent online search behavior related to coronavirus disease 2019 (COVID-19). Valid responses were obtained from 1,000 individuals in both control and intervention groups from Yahoo crowdsourcing users aged ≥18 years in Japan. This survey was conducted from August 4 to August 7, 2023, just before the common Japanese tradition of returning to hometowns. The questionnaire not only collected personal attributes but also gauged responses to COVID-19 information. This information highlighted the early detection capabilities and representativeness of wastewater surveillance compared with sentinel surveillance at medical institutions. At one-week post-survey, we obtained the survey participants' online search history for key words such as "bullet train," "highway," "airplane," and "wastewater." The findings showed no significant differences between the two groups in terms of COVID-19 interest or preventive behavior before information provision, verifying the effectiveness of participant randomization. Wastewater surveillance-based information did not notably elevate understanding or specific intentions regarding COVID-19, such as wearing masks and receiving vaccination. However, it significantly increased interest in, relief concerning the infection status, and general preventive behavioral intentions. Heightened interest and general preventive intentions did not depend on prior interest or behavior. However, those who previously engaged in preventive behavior or who were less interested in COVID-19 exhibited more relief after exposure to wastewater surveillance-based information. Furthermore, this information could slightly influence online searches related to return travel modes, such as highways. In conclusion, information from wastewater surveillance effectively shapes individual perceptions of and responses to infections.