Are you afraid of COVID-19? Motivation and engagement in infection-prevention behaviour in a UK community cohort during the first two-years of the COVID-19 pandemic

ObjectivesTo investigate the relationship between motivation and COVID-19 infection-prevention behaviour during the first two years of the COVID-19 pandemic.DesignProspective longitudinal online survey in a UK community-based cohort.MethodsDuring March/April 2020, n=11,113 people, recruited via the HealthWise Wales research registry and social media advertising, completed the COVID-19 Public Experiences (COPE) study baseline survey, with follow-up at three, 12, 18 and 24-months. Online questionnaires assessed COVID-19 infection-prevention behaviour, perceived susceptibility, fear, personal control over infection-transmission, and reliability of information from media and government. Repeated-measures ANOVA identified changes in motivation and behaviour over time. Multivariable regression models at each time point assessed associations between motivation and behaviour. ResultsCOVID-19 infection-prevention behaviour and motivational variables (fear of COVID-19, perceived susceptibility and perceived control) fluctuated over time as the disease and socio-political environment changed, decreasing overall by 24-months. Regression models for association between motivational variables and COVID-19 infection-prevention behaviour were statistically significant at three- (F(10, 5981)=76.69, p<0.001, adjusted R2 0.112), 12- (F(11, 3732)=48.40, p<0.001, adjusted R2 0.122), 18- (F(11, 3665)=108.34, p<0.001, adjusted R2 0.243), and 24-months (F(11, 3355)=136.20, p<0.001, adjusted R2 0.306). Higher levels of fear, older age, lower perceived personal control over infection-transmission, more trust in government and less trust in social media were associated with more infection-prevention behaviour. ConclusionsMotivation to engage in infection-prevention behaviour during a pandemic is multi-factorial and dynamic. Beliefs about infection and trust in government and media need to be considered in developing effective communication strategies.