To comply or not comply? A latent profile analysis of behaviours and attitudes during the COVID-19 pandemic. Sabina Kleitman, Dayna J. Fullerton, Lisa M. Zhang, Matthew D. Blanchard, Jihyun Lee, Lazar Stankov, Valerie Thompson. PLoS One, July 29, 2021. https://doi.org/10.1371/journal.pone.0255268
Abstract: How and why do people comply with protective behaviours during COVID-19? The emerging literature employs a variable-centered approach, typically using a narrow selection of constructs within a study. This study is the first to adopt a person-centred approach to identify complex patterns of compliance, and holistically examine underlying psychological differences, integrating multiple psychology paradigms and epidemiology. 1575 participants from Australia, US, UK, and Canada indicated their behaviours, attitudes, personality, cognitive/decision-making ability, resilience, adaptability, coping, political and cultural factors, and information consumption during the pandemic’s first wave. Using Latent Profile Analysis, two broad groups were identified. The compliant group (90%) reported greater worries, and perceived protective measures as effective, whilst the non-compliant group (about 10%) perceived them as problematic. The non-compliant group were lower on agreeableness and cultural tightness-looseness, but more extraverted, and reactant. They utilised more maladaptive coping strategies, checked/trusted the news less, and used official sources less. Females showed greater compliance than males. By promoting greater appreciation of the complexity of behaviour during COVID-19, this research provides a critical platform to inform future studies, public health policy, and targeted behaviour change interventions during pandemics. The results also challenge age-related stereotypes and assumptions.
Discussion
The current study is the first to provide a holistic view of the factors influencing behavioural compliance with protective measures during COVID-19. In doing so, we integrated an extensive battery of constructs based on theories from multiple paradigms, including epidemiology, health, differential, and cultural psychology, revealing a complex picture of behaviour and the need for targeted interventions. The novel person-centred approach offers insight into different clusters/groups within the population based on behaviours, attitudes, and key demographics. The sample clustered into two broad groups: those compliant and those not. Whilst the majority fell into the compliant group (90%); 10% of individuals reported non-compliant behaviours and attitudes, which is enough to be cause for concern given the risk of exponential spread.
The compliant and non-compliant groups differed on a number of variables, including beliefs about protective measures, social attitudes, and personality. There was remarkable consistency across the four countries surveyed; and surprisingly, the non-compliant group was not populated simply by young people. The non-compliant group was the second youngest amongst four identified sub-groups, however, and the youngest individuals formed a distinct cluster within the three compliant groups. In the two-class solution, compliant and non-compliant groups did not differ in age. This finding runs contrary to the oft-promoted media stereotype of the young, COVID-indifferent partygoers neglecting restrictions. The picture we discovered was much more complex and key take-away findings are discussed below.
Compliance rates
Overall, we found a promisingly high (90%) rate of compliance, and each of the four countries displayed relatively similar compliance rates. However, we note that this sample was drawn early in the pandemic. These rates of compliance may change as the pandemic prolongs and people become more complacent. Further, country-level differences are likely to become more pronounced given the major differences between countries’ trajectories and regulations since the first wave.
Differences in demographics and attitudes towards protective measures
The compliant group endorsed protective measures as beneficial and effective in leading to better health-related outcomes. By contrast, the non-compliant group appeared concerned with the social and economic cost of such measures. These findings align with health behaviour frameworks which propose that behaviour change is, in part, motivated by perceptions about the efficacy, benefits, and costs of behaviours [13, 14]. Compliant and non-compliant groups differed in their level of worry about COVID-19, consistent with pre-COVID and emerging COVID-19 research showing worry or fear is an important driver of positive behaviour change [2, 3, 6, 8, 12]. These findings support the Health Belief Model and Protection Motivation Theory which suggest that perceptions of severity of the threat, vulnerability to infection, efficacy of protective behaviours, self-efficacy, and perceived benefits and barriers of protective actions are the key beliefs driving health behaviour change and compliance [13, 14]. Although based on correlational data, these results stress the importance of targeting these perceptions to increase compliance.
Notably, on average, the groups did not differ on age, education, or physical health, nor were there differences in pro- or anti-social behaviours. Consistent with previous research, females showed higher rates of compliance than males [15].
The four-class solution allowed for a more nuanced view of the large compliant group, which split into three distinct groups, offering insight into possible motivations behind compliance. The largest group (Class 2) were the youngest, and largely university students. The second largest group (Class 3) were middle-aged and more highly educated; and a minority fit into a third compliant class (Class 4), who were older and had poorer physical health. To our knowledge, although intuitive, no previous study has demonstrated the existence of these classifications within the compliant population.
Personality differentiates compliant and non-compliant groups
Unsurprisingly, the non-compliant group were more extraverted. This group indicated their plans to visit family and friends in the forthcoming week, characteristically extraverted behaviours. However, such behaviours are especially worrisome at the time of pandemic. Although it is difficult to change a psychological trait, to increase compliance, the self-centredness of certain manifestations of trait extraversion may need to be targeted, as they present a health risk factor to others.
Consistent with some emerging COVID-19 findings, the compliant group scored higher on intellect/openness and agreeableness [18, 19]. Contrary to what other COVID-19 research suggests [19, 53] we did not find any differences in conscientiousness or neuroticism between groups. Similarly, perceptions of being resilient and adaptable did not promote compliance during the first wave. This, however, may be the result of sampling during the first few months of the pandemic and the results may change with prolonged exposure to restrictions as the pandemic continues.
Finally, the compliant group were more likely to cope adaptively by self-distraction, planning, and using active strategies; whilst non-compliant people were more likely to cope through denial, substance use, and behavioural disengagement. This research was correlational; thus, no causal mechanism is implied. Instead, we suggest that future studies, should examine whether the promotion and acceptance of more adaptive strategies will lead to better management of isolation and boredom, and help to increase and maintain compliance. If this is the case, intervention strategies should include promotion and education of adaptive strategies, which might be disseminated through mainstream and social media in engaging ways.
Information consumption
The compliant group reported greater use of official government and health information sources than the non-compliant group, suggesting compliant people are better-informed about COVID-19. Also supporting this notion, non-compliant individuals tend to check the legitimacy of sources less than compliant individuals. The groups did not differ in their use of casual information sources (e.g., social media, conversations), highlighting the potential for utilising casual sources for the dissemination of official information. The compliant group checked the news more frequently and expressed greater trust in all information sources than the non-compliant group. Research from the Avian flu pandemic showed that trust in both formal and informal information sources was associated with greater worry, and trust in formal information was linked to greater perceived effectiveness of hygiene behaviours [4]. It is possible that more frequent news-checking has similar impacts on worry and perceptions of protective behaviours, thus promoting compliance. Future studies should determine whether the dissemination of official and reliable information in accessible form (e.g., memes, short messages and videos) via a variety of news outlets, including casual (e.g., social media), may increase rates of compliance in the non-compliant group. However, this would require people to accurately evaluate the legitimacy of information to distinguish between official information and that which is not credible. Thus, targeted interventions focusing on education about how to check the credibility of information, would be of critical importance to foster greater recognition of fake and misleading news.
Attitudes towards government and other cultural factors
Compliant individuals perceived their government as being more truthful than those non-compliant, though there were no differences in reports of satisfaction with their government’s response. Contradictorily, groups differed in their responses when asked whether they thought their government’s reaction to the COVID-19 outbreak was appropriate, too extreme, or insufficient; such that the compliant group was more likely to perceive their government’s reaction to be insufficient compared to the non-compliant group. This aligns with Fetzer et al.’s [34] finding that perceiving the government’s response to be insufficient is associated with greater worry about COVID-19, which in turn may motivate compliance. Conversely, the non-compliant group scored higher on reactance, indicating they are more likely to perceive rules as a threat to their freedom and thus resist them. Consistently, the non-compliant group reported looser cultural norms and higher amorality. A ‘loose’ culture is characterised by valuing freedom, hence is less accustomed to strict social norms such as those imposed during the pandemic. However, we note that the countries sampled are relatively culturally similar. High scores on amorality indicate disregard for moral values within society and are associated with self-interested behavioural choices that ignore COVID-19 guidelines. Whilst no causality is implied, it is possible that emphasising the message of common goals and moral responsibilities at the time of a global health crisis may foster higher compliance rates. Future studies should examine the most efficient messaging to target self-interests, reactance, and perceptions of looser cultural norms.
Implications and future directions
Heterogeneity in the population poses a challenge to implementing widespread behaviour change policies. These strategies should be targeted for different profiles of individuals and focus on increasing the perceived benefits and efficacy of protective measures, reducing barriers, and fostering a functional level of worry. Several directions for future studies have already been proposed. The section below covers further implications of our findings.
Non-compliant individuals appear to distrust and be sceptical of both formal and informal information sources. Further research is needed to identify sources considered trustworthy by this group in order to optimise communication of health advice.
Maintaining compliance as restrictions remain in place for a prolonged period is critically important. Perceptions of being resilient and adaptable did not promote compliance during the first wave in our overall sample. However, it would be fruitful to examine resilience and adaptability beyond the first wave, under the threat of future waves and lockdowns. Further, perceptions of one’s resilience may change as the pandemic prolongs. Some might succumb to the challenges of the pandemic experience, whilst others may discover their strength and experience resilient growth, with both changes having profound effects on mental health.
Lastly, this study was conducted in the early stages of the pandemic. Mobile tracking data from several European countries suggests that people stayed home substantially less during the second wave from late 2020 to early 2021 than they did during the first wave [54]. Thus, further research is needed to examine whether the same profiles and predictors of behaviours emerge in these later stages when rates of compliance and behaviour change have fluctuated.
Strengths and limitations
As a strength, this study addresses the intention-behaviour gap issue prominent in health behaviour research. Our measure of compliance captured behaviours within a critical period rather than asking participants to recall past behaviours. Equally important, we captured a comprehensive range of constructs, providing a holistic view of factors drawn from different psychology paradigms, which extends upon current research by integrating person- and variable-centred approaches to profile and examine characteristics of individuals. These findings may be used to inform strategies for improving and maintaining behaviour change.
We collected data from a large and diverse sample of people in four countries, giving good power and generalisability within that sample. However, a small proportion (18.4%) were collected using snowball recruitment, and using a university student pool (26.3%), contributing to selection bias. We also acknowledge that the interpretation is limited by the fact we sampled ‘WEIRD’ (Western, educated, industrialised, rich, democratic) countries. Though emerging research from other countries has reported findings consistent with ours. For example, distrust in government authorities was associated with non-compliance in Swiss [55], Nigerian [56], Italian, and French samples [57]. Additionally, males and those with less moral values showed lower compliance in Swiss adults [55], as did those with no worry about COVID-19 in Italian and French samples [57]. Further, perceived benefits and efficacy of protective measures have emerged as strong predictors of compliance across samples from a range of countries including Switzerland [58], Ethiopia [59], and China [60]. Nevertheless, we managed to capture a relatively heterogeneous sample, varying in age, gender, levels of education, pre-existing health conditions, and economic situation.
We also used brief versions of several scales and their psychometric properties may limit reliability. However, with few exceptions, most measures had reasonable to excellent reliability estimates. Newly developed measures showed promising preliminary psychometric properties but require further validation.
Moreover, while we captured different levels of education this research did not capture any other socio-economic status (SES) metrics. The emerging results indicate that in the USA, higher SES was related to earlier incidences of COVID-19 cases, but as regulations of social distancing were imposed, the growth of incidents was slower in higher SES countries with lower case fatality rates [61]. Future research needs to determine economic and social conditions that may have disadvantaged different populations as the pandemic progressed within the four countries examined in this research and across the globe. For instance, density of living situations, and reduced capacity to access healthcare, reliable information, and to work from home are important barriers to overall compliance behaviours.
Finally, during the time of data collection, with some caveats, the four countries sampled had employed similar approaches to controlling the spread of COVID-19. This likely contributed to consistency between the four countries surveyed in the profiles identified and their characteristics. Although the consistency in personal characteristics and behavioural patterns across four countries is encouraging, this finding needs to be replicated and extended as the rules and conditions change in these four countries.
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