Public perceptions of risk of COVID-19 infection and transmission in the community: a longitudinal qualitative study

Problem

Members of the public and communities have had to adapt rapidly in recent years to the COVID-19 pandemic. One of the challenges faced by the government and health professionals including primary care has been to implement and encourage transmission- prevention behaviours such as social distancing, hand hygiene and wearing face coverings. Heightened risk perception of COVID-19 has been shown to affect behaviour. Currently, there is a knowledge gap about how risk perception and behaviour changes over time as the pandemic has rapidly changed.We aimed to understand public perceptions of, and responses to, the risks of COVID-19 infection and transmission in the UK during the first 12 months of the pandemic. This includes an understanding of perceived susceptibility to COVID-19, severity of COVID-19 and the determinants of infection and transmission prevention behaviours.

Approach

Longitudinal qualitative interviews as part of the UK COVID-19 Public Experiences (COPE) Study were conducted. The COPE study is a mixed methods longitudinal study comprising of online surveys and remote interviews.Participants were recruited through social media and the research recruitment platform Healthwise Wales. Interview participants were selected from those who had completed the survey using a maximum variation sampling approach to capture a wide demographic range. Each participant was interviewed three times: in May 2020 (n=28), November 2020 (n=24) and March 2021 (n=20). Data were analysed using thematic analysis guided by the Health Beliefs Model and was supported by NVivo.

Findings

Perceptions of susceptibility and seriousness of COVID-19 changed over time depending on the availability of the vaccine, government guidelines, social media, and COVID-19 incidence levels. In latter interviews participants compared the severity of COVID to the common cold. Adherence to prevention measures were broadly followed although there was some confusion with the government guidelines changing frequently and varying by location. Some participants also felt patronised by being told to follow rules without being informed of the science and reasoning behind the measures. Prevention measures were considered more acceptable when interacting with elderly or medically vulnerable people. Some participant's felt strong emotions of anxiety and fear at the start of the pandemic which led to heightened perceptions of COVID-19 risk and the need for additional precautions. A number of participants also reflected on how pandemic fatigue was influencing their behaviour.

Consequences

Members of the public have adapted their risk perceptions of, and consequent behaviours to, COVID-19 during the first 12 months of the pandemic. Our research will help primary care, policy makers and healthcare professionals understand public risk perceptions and tackle pandemic fatigue for COVID-19 and possible future pandemics.