key: cord-0914556-vasr71zd authors: Sturman, Daniel; Auton, Jaime C.; Thacker, Jemma title: Knowledge of social distancing measures and adherence to restrictions during the COVID‐19 pandemic date: 2020-12-15 journal: Health Promot J Austr DOI: 10.1002/hpja.443 sha: 6c765384693c877b795b39b7d21162034f3e7ee6 doc_id: 914556 cord_uid: vasr71zd ISSUE ADDRESSED: With no efficacious treatments or vaccines available, social distancing measures remain the most effective approach for reducing the transmission of the COVID‐19 virus. However, adherence to social distance measures presumably requires knowledge and understanding of the current social distancing restrictions. METHODS: A modified version of the Theory of Planned Behaviour examined the role of knowledge and understanding of current social distancing measures in predicting intentions to adhere to social distancing restrictions. An online survey was administered to respondents (N = 374) in Melbourne, Australia during a period of heightened social distancing restrictions. In addition to measuring respondents’ general intentions to adhere to restrictions, vignettes were used to assess intended behaviour in specific situations. RESULTS: Knowledge of social distancing restrictions predicted intentions to adhere in specific situations, but not general intentions to adhere. Knowledge of restrictions also predicted positive attitudes towards current restrictions and a greater perceived ability to adhere to the restrictions, while positive attitudes was a good predictor of both general and specific intentions to adhere. CONCLUSIONS: The findings suggest that attitudes towards restrictions may influence whether individuals attempt to adhere to restrictions, but knowledge of the restrictions influences whether the intended behaviour actually adheres to current restrictions. SO WHAT? These outcomes indicate that members of the public should be educated regarding the negative consequences associated with the COVID‐19 virus and the capacity of social distancing to reduce transmission of the virus, and a need for social distancing restrictions to be uncomplicated and clearly communicated. The COVID-19 pandemic is a devasting public health emergency, which poses a high risk to vulnerable groups, such as the elderly and those with chronic heart or lung disease, and has the potential to overburden many health care systems. As there are no efficacious treatments or vaccines currently available, social distancing measures remain the most effective approach for reducing the transmission of COVID-19. While authorities across the globe have implemented a variety of social distancing measures, the effectiveness of these measures relies on individuals' adherence to the restrictions. The Theory of Planned Behaviour (TPB) posits that attitudes, perceived norms and behavioural control are the best predictors of intentions to perform a behaviour. 1 The TPB has proved to be a useful framework for predicting intentions to perform various health-related behaviours. 2, 3 In the case of COVID-19 social distancing measures, it is anticipated that more positive attitudes towards the measures (attitudes), a perception that others are adhering to the measures (perceived norms) and a belief that one has the capacity to adhere (behavioural control), will predict greater intentions to adhere to the restrictions. Favourable attitudes towards social distancing measures have been found to predict intentions to self-isolate during the COVID-19 pandemic. 4, 5 Favourable attitudes include the belief that social distancing measures will be effective in reducing transmission of the COVID-19 virus, and the belief that reducing transmission of the virus is important. Researchers have demonstrated that individuals who believe social distancing measures are an effective method for reducing transmission of a virus are more likely to adhere to restrictions. 6, 7 Furthermore, prior to the outbreak of the pandemic, individuals in China reported greater intentions to adhere to restrictions if they believed the social distancing measures were important. 4 The TPB posits that social norms also exert pressure on individuals to perform particular health behaviours. 1, 8 In the context of social distancing, social norms refer to the belief that referents, including family, friends and important members of the public, support and are adhering to the social distancing restrictions. During the COVID-19 pandemic there has been some evidence that individuals who believe that others are adhering to restrictions are more likely to adhere to restrictions themselves. [7] [8] [9] In addition to being motivated to perform a behaviour, the TPB also proposes that perceived behavioural control is an important predictor of intentions. 1 In the context of social distancing, perceived behavioural control refers to the perceived difficulty or ease associated with adhering to social distancing measures. 1, 4 Perceived barriers or obstacles to adherence may include financial pressures or the need to care for sick relatives. Evidence from the early stages of the pandemic support the proposition that greater perceived behavioural control is associated with greater intentions to adhere to social distancing measures. 4,7,8 The TPB relies on the assumption that individuals are aware of the requirements of their intended actions. For instance, it is assumed that an individual who intends to exercise or cease smoking cigarettes understands what these behaviours involve. 10 Knowledge and understanding of current social distancing measures may also directly influence attitudes, social norms and perceived behavioural control. For instance, increased knowledge of health behaviours is typically associated with more positive attitudes towards the behaviours. 15, 16 Furthermore, to accurately assess whether others are adhering to the current restrictions, and the perceived difficulties associated with adherence, an individual presumably requires an accurate understanding of the current restrictions. Consequently, there is a need for research examining the relationship between knowledge and understanding of social distancing restrictions and the main predictors in the TPB. The present study aimed to examine whether a modified TPB including knowledge of current social distancing measures could predict intentions to adhere to social distancing restrictions. To reduce the impact of both hindsight bias and lack of insight regarding reactions to social isolation, the survey was conducted in metropolitan Melbourne, Australia, during stage 4 restrictions (Australia's highest level of restrictions). Furthermore, in addition to a scale asking about general intentions to adhere to the restrictions, respondents were also asked how they would behave in a number of hypothetical scenarios (ie, specific situations). This approach was designed to provide a more accurate assessment of intentions, and to help control for knowledge and understanding of restrictions. It was hypothesised that greater knowledge of the stage 4 restrictions would predict intentions to adhere to stage 4 restrictions, as well as more positive attitudes towards the restrictions, a greater perception of adherence to restrictions, and greater perceived behavioural control (see Figure 1 ). It was also hypothesised that more positive attitudes towards restrictions, a greater perception of others adhering to restrictions, and greater perceived behavioural control would predict intentions to adhere to stage 4 restrictions. However, as lower knowledge of the restrictions may lead to individuals mistakenly believing their intended behaviours will adhere to the restrictions, it was anticipated that knowledge would be a stronger predictor of intentions in specific situations, compared to general intentions to adhere. Respondents consisted of 374 adults who were living in metropoli- The social distancing vignettes consisted of 15 short scenarios which aimed to assess respondents' knowledge and understanding of the stage 4 restrictions, as well as their intentions to adhere to re- Scores from the 12 vignettes in which restrictions were violated F I G U R E 1 Conceptual path model were reverse coded and summed to create a situational intentions score, with higher scores indicating greater intentions to adhere to restrictions in specific situations. As only vignettes in which restrictions were violated were used to calculate situational intentions, the majority of vignettes described scenarios in which the protagonist was violating stage 4 restrictions. General intentions to adhere to the stage 4 restrictions was assessed using a 3-item scale. Respondents were asked to rate the extent to which they agreed with statements about their future intentions (eg, "While the stage 4 restrictions remain in place, I intend to follow the government guidelines concerning appropriate social distance") on a 5-point scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Scores from the three items were summed to create a general intentions score, with higher scores indicating greater intentions to adhere to restrictions. Social norms were assessed using a 3-item scale. Respondents were asked to rate the extent to which they believed family, friends, and members of the general public were adhering to the stage 4 restrictions (eg, 'My friends and family are following the social distancing rules') on a 5-point scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Scores from the three items were summed to create a social norms score, with higher scores indicating a greater perception that people were adhering to the stage 4 restrictions. A 2-item scale was used to assess respondents' perceptions that they have the ability to adhere to the stage 4 restrictions. Respondents were asked to rate the extent to which they agreed with statements regarding their ability to adhere (eg, 'I feel that I have the ability to follow the current social distancing restrictions.') on a 5-point scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Scores from the two items were summed to create a behavioural control score, with higher scores indicating greater perceived ability to adhere to the stage 4 restrictions. After receiving Human Research Ethics approval, the survey was administered via Qualtrics online survey platform over a 3-week period from 28 August 2020 to 15 September 2020. After providing informed consent, respondents were asked to provide demographic information including their age, gender, residential postcode, current living arrangements and current working conditions. Respondents were then asked to complete the social norms scale, the attitude scale and perceived behavioural control scale. Respondents then completed the social distancing vignettes, followed by the general intentions scale. Descriptive statistics are displayed in Table 1 and bivariate correlations are displayed in Table 2 . Two path analyses were run to test the research hypotheses, one with situational intentions as the main outcome variable (see Figure 2) , and the other with general intentions as the main outcome variable (see Figure 3 ). The analyses revealed that, as hypothesised, knowledge of restrictions was a sta- The present study aimed to examine the role of knowledge and Consequently, the relationships observed in this study may be more meaningful than the outcomes observed in research examining only general intentions to adhere. Knowledge was also a significant predictor of both attitudes and The results of the present study also indicate that attitudes towards the current restrictions was a statistically significant predictor of intentions to adhere. This finding supports previous research demonstrating that attitudes towards social distancing measures is an important predictor of adherence to the measures. 4, 5, 7, 17 Compared to social norms and perceived behavioural control, attitudes was a stronger predictor of both general and specific intentions to adhere to the restrictions. This suggests that beliefs that social distancing restrictions are effective and necessary increases the likelihood that individuals will attempt to adhere to the restrictions and will know which behaviours are required for adherence. The findings that attitudes towards restrictions predicts adherence in both general and specific situations, and knowledge of restrictions directly predicts intentions to adhere in specific situations, together suggest that attitudes will influence whether individuals attempt to adhere to restrictions, while knowledge determines whether they know how to adhere. This outcome has practical implications for the way social distancing measures are implemented and communicated to the public. First, the outcomes imply that members of the public need to understand the negative consequences associated with the COVID-19 virus, the capacity of social distancing to reduce transmission of the virus, and the positive impacts associated with a reduction in transmission. Second, the outcomes of the present study also suggest that social distancing measures should be uncomplicated, easy to understand and easy to remember. In addition to improving the capacity of individuals to adhere with restrictions, simplifying or clearly explaining the restrictions may also improve positive attitudes towards the restrictions and reduce perceived barriers to adherence. The present study examined predictors of general and specific in- A further limitation is that the present study examined respondents' knowledge of current social distancing restrictions but did not Using a modified version of the TPB, the present study aimed to examine the role of knowledge of current social distancing measures in predicting intentions to adhere to social distancing restrictions. The findings indicate that knowledge predicts intentions to adhere in specific situations, but not general intentions to adhere. Knowledge of restrictions also predicted positive attitudes towards current restrictions and a greater perceived ability to adhere to the restrictions, and positive attitudes towards restrictions was a good predictor of both general and specific intentions to adhere. Together, these findings suggest that attitudes towards the restrictions will influence whether individuals attempt to adhere to restrictions, but knowledge of the restrictions will influence whether the intended behaviour actually adheres to current restrictions. These outcomes imply that social distancing restrictions need to be uncomplicated, easy to understand and remember, and that members of the public need to be educated regarding the negative consequences associated with the COVID-19 and the capacity of social distancing to reduce transmission of the virus. The authors thank the individuals who participated in this research. The Authors declare that there is no conflict of interest. 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