covid-19 behavioural insights study

COVID-19 behavioural insights study

August 2020

Key findings

68% 46% 63%70%

77% 68% 38%77%

36% 45% 56%24%

would have a COVID-19 vaccine if it were available

68% 46% 63%70%

77% 68% 38%77%

36% 45% 56%24%

agree the Federal Government’s COVID-19 policy is positive for the country

68% 46% 63%70%

77% 68% 38%77%

36% 45% 56%24%

are following COVID-19 guidelines as recommended by the government

68% 46% 63%70%

77% 68% 38%77%

36% 45% 56%24%

agree international government organisations can be trusted to keep the world safe from COVID-19

68% 46% 63%70%

77% 68% 38%77%

36% 45% 56%24%

have the COVIDSafe app working on their phone

68% 46% 63%70%

77% 68% 38%77%

36% 45% 56%24%are extremely concerned about the consequences of COVID-19 for their family

68% 46% 63%70%

77% 68% 38%77%

36% 45% 56%24%

agree they’ve been reasonably happy, all things considered

68% 46% 63%70%

77% 68% 38%77%

36% 45% 56%24%are extremely concerned about the consequences of COVID-19 for themselves

68% 46% 63%70%

77% 68% 38%77%

36% 45% 56%24%

agree the State/Territory’s COVID-19 response actions are in the community’s best interest

68% 46% 63%70%

77% 68% 38%77%

36% 45% 56%24% agree they are fearful that COVID-19 will easily transmit at schools

68% 46% 63%70%

77% 68% 38%77%

36% 45% 56%24%

agree the Federal Government’s COVID-19 response actions are necessary to handle the pandemic

68% 46% 63%70%

77% 68% 38%77%

36% 45% 56%24% agree they are fearful that COVID-19 will easily transmit through community sport

nne Zimmerman School of Nursing and Midwifery, Griffith University

Dr Peta-Anne Zimmerman is an internationally respected clinician, educator and researcher in infection prevention and control, with experience including consultancy work with the World Health Organization (WHO), AusAID, the Asian Development Bank (ADB), the Secretariat of the Pacific Communities (SPC), The Albion Centre and as a member of the WHO SARS Response Team. Her expertise has led her to work extensively in China, South East Asia and the South Pacific, directly on outbreak response, and the development of comprehensive infection prevention and control programs.

COVID-19 behavioural insights study August 2020

COVID-19 behavioural insights study August 2020

Contents 1. Introduction ......................................................................................................................................... 1

1.1 Research aim ............................................................................................................................................................................ 2

2. Findings ................................................................................................................................................ 2

2.1 How are we protecting ourselves from COVID-19? ................................................................................................... 2

2.2 What is your greatest concern about COVID-19? ....................................................................................................... 2

2.3 Information about COVID-19 ............................................................................................................................................. 4

2.3.1 Where do you access information about COVID-19? ................................................................................ 4

2.3.2 Information adequacy for COVID-19 .............................................................................................................. 5

2.4 If a vaccine for COVID-19 were available, I would have it ......................................................................................... 6

2.5 'COVIDSafe' app usage .......................................................................................................................................................... 7

2.6 Government guidelines and response behaviours ......................................................................................................... 8

2.6.1What aspects of the government COVID-19 guidelines are most difficult? ........................................ 8

2.6.2 Behavioural responses ........................................................................................................................................ 11

2.7 What aspect of COVID-19 has impacted on you most? .......................................................................................... 12

2.8 Good changes due to COVID-19 ........................................................................................................................ 14

3. Conclusion and recommendations .................................................................................................... 16

Appendix ..................................................................................................................................................... 18

COVID-19 behavioural insights study August 2020 | 1

1. IntroductionWe are facing a global health crisis unlike any other, with 29 million cases of COVID-19 reported and in excess of 900,000 deaths.

Historically, pandemics during our lifetime have been limited to

influenza or a locally acquired virus such as SARS. These

outbreaks are limited in scope and impact on humans, until now.

However, 2020 launched global health into a new, worldwide

unmitigated threat that is unwieldy in scope and treatments.

Unlike other health risks or disaster management scenarios such

as the 2009 influenza pandemic, COVID-19 represents a new

threat situation that has unmitigated precedence in terms of

behavioural responses. As such, it is critical to examine

behavioural responses to this threat. This research takes an

acute review of behavioural responses related to COVID-19,

to contain and reduce the transmission of COVID-19.

As coronavirus outbreaks surge worldwide, scientists race to develop a vaccine. One of the greatest threats

to human life is due to the very high potential of community transmission. COVID-19 is highly contagious

with those infected, infecting up to another 2.5 people. In response, governments have launched various

action plans, from physical distancing measures to total lock downs. COVID-19 raises the uncommon

situation whereby the interrelatedness of all levels of government, community, and the individual level

protective behaviours becomes the focus.

Risk and protective behavioural factors of COVID-19 have contrary motives. Risk behaviours may include

refusal to adhere to guidelines and instructions (such as self-isolation, quarantine and physical distancing). In

contrast, there is the emerging issue of individuals engaging in over-protective behaviours, and as such are

neglecting their regular health care. The resulting impact of not consulting health care professionals not only

puts the individual at considerable risk, but impacts the capability of health services to care for an expected

rise in demand when society regulates. There is also the risk this may coincide with a wave of COVID-19

infected patients. Between these two extremes there are those individuals that perceive the virus as a critical

risk, and as such are more likely to follow public health guidelines to protect not only themselves, their family

and loved ones but also protect society more broadly. It is within this context that risk perceptions influencing

behavioural outcomes are likely to fall along a continuum (that is, from non-protective, to protective, to

over-protective), but paradoxically, how people receive risk is not necessarily correlated to actual risk.

Behavioural insights for COVID-19 are of urgent importance, and this research is highly relevant considering

that Australia has not reached the peak of the pandemic. In other countries that have not contained the

COVID-19 outbreak, the spread of infection was swift with many associated deaths. In Australia, the severity

of the outbreak has been minimised by a number of successful government driven and community/individual

enacted measures, but as complacency sets in, there is a risk of a devastating second wave. At present,

COVID-19 cannot be managed without a novel vaccine, making this research even more pertinent

considering that management of future outbreak rests on the individual's ongoing vigilant behaviour.


1.1 Research aim The overall aim of the study is to understand the factors that contribute to individual COVID-19 compliance.

Developing a predictive model will better enable policy makers to better comprehend influencers, thus,

enabling a more accurate response prognosis.

Invitations to participate in the online survey began on Thursday 25 June and circulated through email

dispersal (cultural community groups, primary health networks, and health consumer groups) and social media

(LinkedIn, Twitter and Facebook). Also, the research team purposively drew on professional and personal

networks; yielding a total of 523 surveys. Many of the respondents were female 65%, with 17.6% male,

17.4% undisclosed, and more than half live in Queensland (57%), see Appendix A for full demographic details.

2. Findings 2.1 How are we protecting ourselves from COVID-19? Initially, we wanted to find out how participants self-rated their

behaviour concerning government guidelines. Members of the

research team attended industry forums and discussions with

health consumer experts resulting in three distinct behavioural

categories (1) non-protective route to coping (living life as usual),

(2) protective route to coping (following guidelines as

recommended), and (3) over-protective route to coping (doing

more than recommended).

We wanted to understand if age was an influencer of behaviour.

However, here was no significance in any of the relationships

between age behaviour types. This may be due to the small number

of people in the sample that identified with ‘living life as usual’.

2.2 What is your greatest concern about COVID-19? Overwhelmingly the qualitative comments regarding the participant's greatest concern were that they or

their family would contract COVID-19, and the resulting long-term health implications.

‘My 24-year-old daughter who has a terminal illness and my 90-year-old mother being

infected because they cannot fight it and will not be ventilated and they will die by themselves.’

‘Friends and family who are high risk contacting it having a bad outcome or healthy friends or

family being unlucky and die or have long term health effects.’

‘That I will either die or be even further disabled with long term chronic illness (or that my

children will be), especially as my youngest child is completely dependent on me and there is no

one else who can and will care for her.’

In our sample, 70% said they were

following COVID-19 guidelines as

recommended, 25.6% said they were

doing more than recommended to protect

themselves, and 4.4% were living life as usual.


The confronting uncertainty through and beyond the crisis has caused unease. The unprecedented nature and

constant changes have left many in doubt about the future 'normal' and the ability of society to readjust.

Personal economic impact, job losses, and economic recession were all related to an unclear future.

‘That there is no evidence that we can expect a cure for C19.’

‘My greatest concern is about what the "new normal" will look like once we have a vaccine for

COVID-19. I worry that as a society, we cannot simply lock-down every time something like

this happens in the future.’

‘That we cannot learn to live with the reality of the current situation and make the necessary

adjustments needed to get on with life.’

‘That we cannot learn to live with the reality of the current situation and make the necessary

adjustments needed to get on with life.’

‘The job market, unemployment and my future career prospects.’

In particular, community transmission resulting from complacency,

refusal, asymptomatic infection, and those not following guidelines were

most common.

‘People not taking this virus serious, being complacent and putting others and themselves at risk

resulting in a second pandemic.’

‘The lack of understanding and application of precautions in some communities. Some areas

within the state of Queensland do not follow guidelines. Even though they have people from

other areas of Australia travel to this area increasing the risk.’

‘Selfish non-compliant citizens who have a lack of concern for others, such as

immunocompromised persons. The government is more concerned with the economy than

people's lives and adequate social supports, to include funding to all levels of healthcare, patient

safety and adequate staffing.’

Also of great concern was the impact and reliance on other people’s behaviours to stay safe.


Participants were asked about the extent that they are concerned about the consequences of COVID-19. As

shown in Table 1, participants were most concerned about their family and friends compared to themselves.

Table 1: Concern about the consequences of COVID-19

Item Mean score

For your family 3.90

For your close friends 3.51

For yourself 3.50 Note: Items were measured on a 5-point Likert type of scale

The perceived severity of COVID-19 was a worry for most participants. Most people believe that COVID-19

is highly contagious and will have severe implications for long-term health.

Table 2: Perceived severity of COVID-19

Item Mean score Covid-19 is highly contagious 4.48

Contracting COVID-19 will have severe implications for my long-term health 3.79 Note: Items were measured on a 5-point Likert type of scale

2.3 Information about COVID-19 2.3.1 Where do you access information about COVID-19? In the survey, most respondents indicated that they accessed information about COVID-19 from government

agencies (such as, Premier, State Ministers, and Federal Government). Online websites and healthcare

professionals were also common sources of information. Interestingly, social media, friends and family, and

religious groups were seldom used.

Table 3: Information sources

Information source Mean score

Government agencies (e.g. Premier, State Ministers, Federal) 3.8

Online (internet) websites 3.4

Mainstream media (TV, radio, newspapers) 3.3

Health care provider (e.g. GP, specialist, allied health) 2.8

Family and friends 2.5

Social Media groups (e.g. Facebook) 1.9

Community groups 1.5

Religious groups/faith leaders 1.2

Note: Items were measured on a 5-point Likert type of scale


2.3.2 Information adequacy for COVID-19

When asked what further information they required about COVID-19, many of the responses were about the

accuracy of the information and avoiding confusing or contradicting information, like what is currently

available.

‘When I look up the government websites for information I feel like they're unclear and do not

have the level of information I need, like restrictions and things like that. I also feel like when

you listen to ABC radio, government websites, and other news sources you hear different and

contradicting information. I wish it was much more uniform in the advice given and also a way to

find out specific information.’

Some comments suggested that a peak body that is not the government be responsible for disseminating

information. Furthermore, messages have a more global perspective, including treatment protocols overseas.

‘I'd like an authoritative body, not the government deciding and giving the information—

updating it through our eHealth record. The piecemeal stuff at the height of the pandemic was

contradictory and confusing i.e. numbers at weddings and homes etc. A simple flow chart—

yes/no then do a/b, rather than the set figures and arbitrary measures that many didn't

understand or take seriously... so the access or method is the problem not the facts about the

disease.’

In the remainder of the comments, there was equal concern regarding 1) testing (test accuracy, timing of

testing), and 2) confirmed cases (advice and interactive map that shows active and past cases).

Over 70% of participants confirmed that they had access to all the

information that they required about COVID-19.

72%Yes


2.4 If a vaccine for COVID-19 were available, I would have it

Of those that would not take the vaccine, the following concerns were raised:

1) side effects, 2) quality of testing, and 3) Speed of vaccine development.

‘Would be concerned about side effects.’

‘Immunity is an issue—vaccines set off mast cell activation syndrome.’

‘I would want to thoroughly understand what the vaccine was and how it works before rushing

into it also have an autoimmune disease so need to fully understand any further impacts to my

health.’

‘I would want to thoroughly understand what the vaccine was and how it works before rushing

into it also have an autoimmune disease so need to fully understand any further impacts to my

health.’ ‘I would not inject anything into my body especially a vaccine that is rushed.’

Many participants were concerned about the vaccine

effectiveness, stating that it could be outdated quickly due to

virus mutation and that generally flu vaccines were not effective.

Some displayed a lack of trust in the preparation of the vaccine.

‘I live in a relatively safe rural area and the vaccine

will be outdated quickly like the flu vaccine.’

‘There is NO RNA flu vaccine that is 100% effective or safe. Bill gates behind it? No thanks.’

‘I'd be very wary. Would depend a lot on how the vaccine was developed. Also I contribute to flu

vaccine weekly stats, and they show low efficacy, so I've rethought. I have low trust in this

whole area.’

68% of participants said that they would trial a COVID-19 vaccine, and only 18% said no.

68%Yes


2.5 'COVIDSafe' app usage

Most people that did not have the app working on their phone stated privacy issues,

a distrust in the government’s handling of the information, and that the

government’s reliance on the app may cause complacency in decision making.

‘Mistrust of data use by various agencies and mistrust of security as to who will have access and

that the leaders and rule setters will change the rules.’

‘It's not safe, a way for the government to get 'in the door' for all personal information. As well

as hacking of that information, it's happened before.’

‘I refuse to reinforce government and public reliance on an app that was not accurately

developed or tested, and which remains inaccessible to many people. When the governments do

better on accessible communication and information, and make better decisions, then I will

reconsider this. Otherwise it's creating a false sense of security—and yes I am qualified in

behavioural science.’

Technological issues were also frequently reported for abandoning and app refusal. Respondents countered,

that their phones were too old, could not download the app, problems with software and hardware issues.

‘It's rubbish—a lazy federal government pretending to do something.’

‘It's not reliable. I rarely leave my home town. Not at risk.’

‘It severely drains the phone battery. I have a tracking app on my phone that records

everywhere I've stopped and started moving. If the COVID app didn't drain my phone so much

I'd have it installed.’

Many people believed that the app was ineffective, or they did not need it for their circumstances. A small

group had demonstrated a level of complacency with; ‘no real reason’, ‘didn't bother,’ or ‘kept forgetting to

download it.’

‘Six million citizens sign up and it's been ineffective in tracing COVID-19 infected persons.’

‘I don't go out and so don't come into contact with anyone. Plus, as far as I can tell, it hasn't

identified anyone who has COVID-19 yet, so I'm not sure it's something that works effectively.’

‘I will communicate with authorities as needed. In my experience tech like this hasn't worked

anyway. I did observe that numbers required for the app to work were reached and may have

reconsidered if they were not.’

The number of people with the COVIDSafe app working on their phone was 46.5%, compared with 40.9% that did not.

46.5%Yes


2.6 Government guidelines and individual response behaviours 2.6.1What aspects of the government COVID-19 guidelines are most difficult?

Many commented that following the guidelines was easy and,

‘they didn't think the government guidelines are rigid enough’,

and ‘they are all reasonable and needed to keep us all safe.’

During COVID-19, we have all heard the spin on the ‘we’re-all-in-the-same-boat’ metaphor as a call for

compassion. The twist is that: we are NOT in the same boat—even if we are in the same storm.

Everyone's circumstances are different, and for most, the greatest difficultly was their individual life situation.

And for many, the difficulty in physical distancing and lack of human contact.

‘Working full time, 12 hour shifts. Home schooling a vulnerable child. Recognise keeping kids

away from school was relevant but additional strain.’

‘Not having in-person meetings of my community groups—adapting to use the online meeting

platforms, Zoom and Microsoft Teams.’

‘I love hanging out with friends so when restrictions were more strict, this was hard at times.

Further, I am a Christian and so I am missing attending church in person.’

‘Crossing the border to Queensland when we live in Tweed so I can see my daughter and

grandson. Coming up to the one- year anniversary of my son's death and this is upsetting.’ ‘The lack of contact with family and friends is hard on mental and social health.’

Interestingly, most participants disagreed (73%) that the government COVID-19

guidelines were difficult to comply with, and only 8% agreed.

For me, complying to government COVID-19 guidelines is very difficult

1 Strongly disagree 2 3 4 5


In a fast-changing environments, such as what we are experiencing now, change and ambiguity are the new

normal, but causes a major impediment to achieving government guidelines. Many participants found that

making decisions was difficult as they were uncertain of what was expected by the government.

‘The fact that the information is so ambiguous and everyone does what they want, that the rules

are only enforced sometimes and it seems to be very dependent on what you look like, where

you live and your occupation as to whether or not you will be questioned or monitored.’

‘Confusing information between Federal and state governments, so I only follow guidelines from

local state government.’

‘Confused directions about wearing masks.’

‘The guidelines are difficult, understanding what the current guidelines was. They changed and

updated them so quickly that at one point the message was quite muddled.’

‘Lock down has been hit and miss, can't go to a NRL game with people but shopping is okay, e.g.

Bunnings and social distancing LOL.’

In attempting to follow guidelines, another major issue was the witnessing the violation of social norms. Non-

compliance within the community had participants’ feeling helpless while observing other people's actions.

‘Watching these demonstrations happen should never be allowed while the rest of the general

public for the most part comply.’

‘Watching others not following guidelines and knowing the impact on others.’

‘Not being able to sit in the park, absolutely absurd given the fact that mass protests were approved by the courts.’

Social/physical distancing was another important theme. Many found distancing

difficult, whether it was due to their work circumstances, while shopping, or

staying away from others.

‘Social distancing when shopping does not happen.’

‘Sending my kids back to school while still social distancing, etc. seems counterproductive: like

saving pennies and then throwing them down a storm drain.’

‘Social distancing is difficult when have no vision as it relies a lot on others, being blind means I

have to touch surfaces more than the average person, my work as an essential worker has

created significant stress, financially life is a challenge for many including myself during these

tough times. Not recommending mask use means we cannot wear them at work.’


Travel restrictions were also a significant cause of adversity. In particular, the Queensland/New South Wales

border caused most angst.

‘The border closure, as my partner lives over the border, and not being able to have a physical

relationship and spend quality time with them has really affected my partner and I.’

‘Border closures and visiting my new grandson interstate and assisting my daughter who is a

new first baby mum with minimal friend support and no family support where she lives. She is 1

hr 15 mins drive from my house but is in NSW.’

Government payments provided a much needed short-term

fix, and people have relied on friends and family for support,

such as a spare room to stay to avoid ‘sleeping rough’.

‘My partner cannot work. In September, that will

become a huge issue for us financially, unless

they extend the support. The large events he

needs to make an income are banned.’

‘I work with people with dementia who live in the community. My clients are not all in a small

area. I have two clients I take out for a car ride and singalong. The stimulation and looking at

suburbs etc. that bring back old memories. We rarely leave the car. During COVID I was taking a

small in car picnic. If we needed a toilet I had a few in isolated places that I often use with clients

as crowds can often cause anxiety. We always sanitize going in and coming out. I found these

people, my clients have progressed into dementia and depression so far because of the lack of

stimulation and care during COVID.’

The economic and quality of life cost has been significant.


Participants were asked about the extent that they agreed to the following statements about state,

government and other organisation actions during COVID-19.

To a lesser extent the Federal government’s policy were positive for the country and that international

government organisations can be trusted to keep the world safe from COVID-19.

Table 4: Government actions during COVID-19

Item Mean score

My State / Territory's COVID-19 response actions are in the community's

best interest

4.1

The Federal Government's COVID-19 response actions are necessary to

handle the pandemic

4.1

The Federal Government's COVID-19 policy is positive for the country 3.8

International government organisations (like the World Health Organization

- WHO) can be trusted to keep the world safe from COVID-19

3.0


2.6.2 Keeping safe—behavioural responses In response to the perceived threat of COVID-19, participants used multiple approaches to remain safe. In

particular, they were most likely to engage in hand and surface hygiene, and social distancing measures.

Restricting interaction with others and confinement to the home were also common, but to a lesser extent.

Table 5: Behavioural responses

Behaviours Mean

When I return from outside I perform hand hygiene by using hand sanitizer or

washing my hands

4.9

Maintain social distancing 4.4

Clean and disinfect surfaces and equipment to prevent the spread of the virus 3.9

Strictly monitor and limit the number of people I come in contact with 3.8

Severely limit going outside the home even when restrictions are relaxed 3.0

Stockpiled food and other essential items 2.1

Stockpiled medicine 2.0

Have essential items delivered by trusted family/friends even when restrictions

are relaxed

1.9

Wear a medical grade face mask when out 1.8

Wear a homemade/fabric face mask when out 1.4


Confidence in State/Territory’s and Federal government response actions was very high.


2.7 What aspect of COVID-19 has impacted on you most? The effect of isolation was the preeminent factor identified for negative personal impact. Worry and fear of

community transmission, and, difficulty social distancing was common. The main causes of distress were from

1) having to isolate at home, 2) home schooling, 3) not being able to physically distance, 4) adjusting to the

‘new’ normal, and 5) not being able to socialise with family and friends.

‘Staying inside and not meeting people out as well as attending uni online was very hard

mentally.’

‘Ability to work. It has caused much stress. Having kids at home and home schooling, while

trying to do my own work. It was extremely hard!’

‘Not having respite available for mum. I desperately need a break. I've had to step up to cover wound care, personal care, everything for both mum and my husband I'm exhausted.’

A loss of employment or changing the work environment has had severe impacts on individuals and families.

‘The loss of work. I work in the events and hospitality sector and was stood down from my role

in March this year… The loss of income and job uncertainty has been the hardest, especially with

a young family to look after.’

‘I was made redundant and have been isolating and have only left the house for essential medical

monitoring of my chronic illness twice since April.’

Only one participant discussed the implications of having had contact with a positive COVID-19 case.

‘It has impacted our household hugely! The stress of possibly bringing it home has been the

worst. The added work in every single thing I do. I'm excluded from anywhere that wants a

signed declaration of contact with a positive or potentially positive patient—even my GP when I

had a back injury I couldn't go to because I have a known contact, yet I am sure my PPE had not

been breached… I have felt like I was considered dirty and excluded from basic things like

medical treatment. I have been isolated and absolutely exhausted because I still have to run a

household and parent and work but also have so much more stress daily.’


Perceptions of other individual's behaviours were a source of discontent. There is a reported lack of ‘pro-

social’ behaviour witnessed through the absence of adherence to guidelines.

‘People not adhering to official advice about distancing and precautions.’

‘People hoarding goods.’

‘Not being isolated physically… But “feeling” isolated in

how serious this is. I am gobsmacked at the general

consensus of people cruising around thinking the rules

don't apply to them.’ ‘Other people being ignorant of social distancing and the "it won't happen to me" attitude.’

The crisis has exposed the inequitable treatment of minority groups, including those that are vulnerable.

‘Being a minority, when the world is based on the privileged majorities. The majority approach

adopted by public health "experts", and their abysmal lack of expertise in human behaviour, is

the basic flaw in how we educate in that field. Not one of the mental healthcare support services

splashed across media are appropriate for people with communication disabilities, and telehealth

is also flawed for multiple reasons. Yet we are all expected to magically access everything, and

as recommended in a media that many of us have difficulty in accessing. The ignorance and/or

arrogance is gobsmacking and depressing. Am I angry? Yes. We feel even more expendable right

now. I fear widespread pandemic fatigue and the ultimate adoption of "survival of the fittest"

mentality in Australia. Which is fine for eugenicists, except that nobody actually knows the true

outcomes of COVID-19 yet.’

As reported in previous sections travel restrictions continued to cause negative impact. People recorded

being ‘unable to see family interstate, to travel overseas to see parents, and travel for work and conferences’. The border crossings between Queensland and other states has caused difficulty for many to attend health

appointments, work and school.


2.8 Good changes due to COVID-19 It was positive to discover that there was a silver lining to COVID-19.

‘Yes, being at home with my kids, spending time

with them and being a family, this has been the

bonus. Not having to rush around with work and

kindy and everything else that comes with full time

working and no family support here (our family all

live overseas). I've enjoyed being able to read and

also do some online courses to upskill. COVID has

been the best and worse times, but has certainly

given a new perspective on life.’

‘Where do I start? Having the kids do school from home, the relaxed pace of life during

quarantine, time to make sourdough bread and cheeses, all the COVID related forums/info

sessions/discussion via zoom, being able to get a prescription written over the phone, doctor

appointments by phone or telehealth, not having to shake people's hands, COVID memes, not

having to think about what I'm wearing every day, not having to worry about the dog (she's a

little overzealous/scary) because nobody was visiting, not having to pack school lunches, I liked

the mindfulness required when doing routine things like going to the shop, the caring

community feel when walking in my suburb... I could go on...’

Long-standing systemic health and social inequalities have been emphasised by COVID-19. For example,

some racial and ethnic minority groups have increased risk of getting sick and dying from COVID-19, with

data from England showing that minorities are over-represented. A more objective global perspective from

countries that are excelling and succeeding in managing the virus could help to inform Australia.

‘Definitely—minorities are becoming more vocal and less willing to submit to dominant

ideologies, including ideologies that espouse individual responsibility… Pandemics don't

discriminate based on individual responsibility, and we are all interconnected. Thankfully

minorities seem to be more supported by a global majority of young people, who understand the

tyrannies, monopolies, and failures of dominant groups. I see this as a time of reckoning, with

great potential for change and innovation. Plus, this has highlighted the critical role of

transdisciplinary research and approaches to public health, healthcare, communication, and

government. The important roles of end-users in R&D, policy, and practice will hopefully be

much better understood after this (I won't hold my breath though).’

Significantly, we found that people have demonstrated a slowing down of their lifestyle, and spending more time with family, hobbies,

and reflecting on what is important in life.


Others are pleased with greater awareness of personal space, improved community hygiene, hand washing,

and physical distancing.

‘I feel people will practice better health hygiene. My experience is that there's a better sense of

community awareness and looking out for others who may need assistance.’

‘I am more vigilant with my hygiene during this 'flu' season than I've ever been. I think the hand

washing and sanitising will stay with me even after COVID.’

And, other positive fallouts include increased use of technology, allowing people to work from home, and the

adoption of telehealth.

‘Working from home, less traffic, less pollution, families enjoying spending time with each other,

enjoying the simple pleasures in life, appreciation for the simple things, the humour, zoom

meetings taking less time than face to face, all of the creative ways people are thinking in doing

things differently, exercise classes online, awareness of basic hygiene which we should be doing

normally.’

‘Telehealth, hospital in the home. Recognition by health services that consumer input is essential

to making it work, for consumers. Driving far less as most of both mums and my husband's

appointments were via phone. Would have preferred a video link for some of them. As a carer

this saved me so much time that would have been spent driving to and from appointments,

sitting in waiting rooms for appointments that are often sadly running late.’

Many also consider that the change in the way we work has reduced the necessity of travel and a curtailing of

consumerism that has conclusively benefited the environment.

‘Experiencing a low people world again has been a true miracle. Also it has produced a fantastic

fall in carbon emissions… Reading about wild animals emerging in the absence of humans.’

‘The planet is healthier— less cars, less flights. Less crowds. Government was less "political" for

a while.’

It is important to note that a large number of participants reported that ‘nothing good’ had come from COVID-19.


3. Conclusion and recommendations As COVID-19 outbreaks surge worldwide, the race is on for all countries across the globe vying for the claim

of developing the first vaccine. In the meantime, society is adopting personal behaviours to stop the spread

and community transmission of the disease. Due to the COVID-19 characteristics and being highly

contagious, the best defence we have is to enact personal protective behaviours that act to protect the

individual, as well as the community.

In this research, we identified three broad groups of individuals, based on their behavioural characteristics

during this crisis:

1. non-protective route to coping (living life as usual)

2. protective route to coping (following guidelines as recommended)

3. over-protective route to coping (doing more than recommended).

These categories provide us with important insights. Firstly, we need to do more to understand the

characteristics of group 1, who are not following guidelines and who are living life as usual. Our initial

investigation into age and other demographic factors were inconclusive. Also requiring further investigation is

group 3, those practicing over-protection, as they may be at risk of neglecting their emotional and physical

health.

Participants perceived the threat of COVID-19 as high, but were more concerned with their family or friends

acquiring the virus compared to themselves. The most common form of defense was hand and surface

hygiene, and social distancing measures. People also engaged in behaviour such as strictly monitoring and

limiting interaction with others and severely limiting going outside the home. Further research could examine

the affect that reduced interaction and home quarantine have had on personal wellbeing especially in

vulnerable groups.

Participants were generally well-informed, gaining knowledge from reputable sources such as government

agencies. However, inaccurate, confusing and contradicting information was identified as being problematic.

In this dynamic ever-changing environment, it is expected that information overload be challenging. In dealing

with too much information, individual’s decision-making ability becomes impaired. Therefore, tailored

information for specific groups within the community will reduce confusion, frustration and errors.

In regards to receiving a COVID-19 vaccine, almost 70% of participants agreed that they would accept the

vaccine with only 18% refusing due to concerns raised over side effects, quality of testing, and speed of

vaccine development. We found a significant relationship between those who have had flu vaccinations in the

past and those that would assent to the COVID-19 vaccine. This suggests that overcoming the challenge of

getting everyone to vaccinate lies in focusing on the attitudes of the anti-vaccinators. In this study, we found

that perceived vaccine safety as the most common reason for refusal. Drawing on past research, anti-

vaccinators tend to exaggerate risk. Therefore, educating with clearly articulated messages that emphasise

the risk of not vaccinating on an individual level is highly recommended.

COVID-19 has been exemplified as a multisystem crisis that affects people on many different levels. What we

have found that, while we are in the same storm, we are definitely not ‘in-the-same-boat’. With everyone's

circumstances being different, long-standing systemic health and social inequalities have been emphasised.


The results of this research are subject to a number of limitations. Firstly, due to the constantly changing

nature of COVID-19 within Australia (that is, outbreaks, restrictions, guidelines, medical advice, and so on)

we expect that the conditions would be different for each of the respondents. However, many of the

questions addressed attitudes to aspects of COVID-19, and although the environment is ever-changing,

generally attitudes remain consistent. Also, since a snowball approach was used in the online survey

distribution, it is expected that a self-selection bias may occur with those interested in the phenomena

choosing to complete the survey.

Acknowledgments A sincere thanks you go to Gold Coast Health Service members Kathleen Carlyon and Noela Baglot for their

constructive comments and feedback. Also, to individuals and organisations that shared the survey within

their networks and those that completed it.


Appendix: Sample profile Variable Category Frequency Percentage Age 18-24 41 7.8

25-34 42 8

35-44 74 14.1

45-54 117 22.4

55-64 93 17.8

65 + 70 13.4

Gender Male 92 17.6

Female 341 65.2

other 4 1

Is English the most common

language spoken at home?

Yes 413 79

No 21 4

State living in Qld 300 57.4

NT 3 .6

NSW 61 11.7

VIC 30 5.7

SA 8 1.5

WA 13 2.5

TAS 16 3.1

Identify as the following Aboriginal and/or Torres Strait Islander 9 1.7

Maori 3 .6

Pacific Peoples 6 1.1

Culturally or linguistically diverse 24 4.6

LGBTIQ 21 4

Sole parent 37 7.1

Other 70 13.4

Do you or your family (living with

you) have a disability?

Yes 85 16.3

No 352 67.3

Highest level of education Less than high school 3 .6

High School 58 11.1

Trade or college 87 16.6

Bachelor degree or higher 289 55.3

Current employment status Working full-time 179 34.2

Part-time or casually 86 16.4

Retired 65 12.4

Unemployed seeking work 26 5

Home duties 13 2.5

Studying 40 7.6

Other 24 4.6


Variable Category Frequency Percentage

Living arrangements Live alone 72 13.8

Live with family 333 63.7

Live with friends/flat mates 32 6.1

Have children under 18 at home Yes 129 24.7

No 308 58.9

Over 60 living with you Yes 92 17.6

No 345 66

Do you or your family (living with

you) have one or more chronic

illnesses or are immunosuppressed?

Yes 154 29.4

No 283 54.1

Which of the following best

describes your situation?

I'm following the COVID-19 guidelines as

recommended by government

366 70

I'm doing more than recommended to

protect against COVID-19

134 25.6

I'm living my life as usual 23 4.4

If a vaccine for COVID-19 were

available, I would have it?

Yes 360 68.8

No 77 17.7

I have the 'COVIDSafe' app working

on my phone

Yes 243 46.5

No 214 40.9

In the past I have had the seasonal

Flu vaccine?

Yes 344 65.8

No 93 17.8

*Percentages not adding to 100 is due to missing data

Research team

Dr Joan Carlini Department of Marketing, Griffith Business School [email protected]

Dr Carlini’s scholarly work specialises consumer behaviour. She has extensive research experience focusing on high impact projects resulting in social and economic benefits. She has chaired the Gold Coast Hospital and Health Service Consumer Advisory Group and works with cross-disciplinary researchers.

Dr Marie-Louise Fry Department of Marketing, Griffith Business School [email protected]

Dr Marie-Louise Fry’s research brings practical and theoretical insight into understanding consumption behaviour across a variety of marketing arenas. She specialises in social marketing giving particular attention to why people do things that are manifestly bad for them, why they won’t do things that are obviously good for them and what will it take to reverse that.

Professor Debra Grace Department of Marketing, Griffith Business School [email protected]

Professor Debra Grace’s research and teaching interests lie across a broad spectrum of marketing topics, including consumer psychology, services marketing, branding, franchising, marketing metrics, internal marketing, social media marketing, international education marketing and self-marketing. She has numerous publications in high-ranking international marketing journals.

Melissa Fox Health Consumers Queensland [email protected]

Melissa Fox is CEO at Health Consumers Queensland. With almost fifteen years as a consumer representative/advocate, Melissa has seen firsthand the positive impact that consumer engagement has on health outcomes for Queenslanders. She is passionate about challenging health services to go beyond ‘tick-a-box’ engagement and empower consumers to partner meaningfully in order to design, deliver and evaluate health services which provide safe, integrated consumer-centred care.

Dr Peta-Anne Zimmerman School of Nursing and Midwifery, Griffith University [email protected]

Dr Peta-Anne Zimmerman is an internationally respected clinician, educator and researcher in infection prevention and control, with experience including consultancy work with the World Health Organization (WHO), AusAID, the Asian Development Bank (ADB), the Secretariat of the Pacific Communities (SPC), The Albion Centre and as a member of both the WHO SARS Response Team (2003) and COVID-19 Response Team.

CRICOS No. 00233E

mailto:[email protected]





https://www.griffith.edu.au

covid-19 behavioural insights study

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