The influence of dissonance induction and assessment reactivity in improving adherence to Covid-19 precautionary measures: a cluster randomized controlled trial

Chandu, Dr. Viswa Chaitanya; Lingamaneni, Dr. Krishna Prasad; Pachava, Dr. Srinivas; Baddam, Dr. Venkat Ramana Reddy; Marella, Dr. Yamuna

BACKGROUND: In the context of the Coronavirus Disease (COVID-19) pandemic, adherence to suggested precautionary measures has been highlighted to be extremely important in preventing and curtailing the spread of COVID-19. However, strict adherence to precautionary measures could be very demanding. MATERIALS AND METHOD: This cluster randomized controlled trial done among 1517 undergraduate dental students tested the effectiveness of ‘Dissonance Induction’(DI) and ‘Assessment Reactivity’(AR) in improving adherence to WHO suggested COVID-19 precautionary measures as compared to a control group. At baseline, participants in the DI group were tested for their knowledge on COVID-19 precautionary measures, immediately followed by assessment of their adherence to these precautionary measures. This methodology was adapted so as to systematically reveal to the participants the poor adherence to their self-held cognitions, should there be any. The magnitude of dissonance was measured as the proportion of such dissonant cognitions held by an individual. In the AR group, at baseline, participants were inquired about their attitudes alone towards COVID-19 precautionary measures. The control group was neither assessed for knowledge and adherence nor for attitudes towards the precautionary measures at baseline. Two weeks after the administration of the aforementioned interventions in the DI and AR groups, the three study groups were assessed for adherence to COVID-19 precautionary measures. RESULTS: The follow-up adherence scores in the DI group were found to be significantly higher (15.11±4.1) compared to the AR (13.13±2.01) and control (12.87±2.97) groups as analyzed by Kruskal-Wallis ANOVA (H=243.5; P<0.001). Wilcoxon signed-rank test showed that the adherence scores significantly improved in the DI group from baseline to follow-up (z=-8.84; P<0.001). Magnitude of dissonance at baseline was found to be a significant predictor of follow-up adherence scores (R(2)=0.255). CONCLUSION: This study found that ‘dissonance induction’ is an easy to administer intervention in this moment of global crisis to bring an immediate and significant change in the people's adherence to COVID-19 precautionary measures.