Population anxiety and positive behaviour change during the COVID-19 epidemic: Cross-sectional surveys in Singapore, China and Italy

Jane M Lim; Zaw Myo Tun; Vishakha Kumar; Sharon Quaye; Vittoria Offeddu; Alex R Cook; May Oo Lwin; Shaohai Jiang; Clarence C Tam

In all three countries, higher acceptance of restrictive control measures and information sufficiency were strongly associated with greater positive behavioural response. Respondents' anxiety was also a catalyst in their adoption of positive behavioural responses to reduce risk of infection -in particular, Singaporean respondents with higher levels of anxiety and self-efficacy were more likely to adopt positive preventive measures, consistent with previous studies done during the 2009 influenza A/H1N1 pandemic. 9 Conversely, Singaporean respondents with greater confidence in authority were less likely to adopt positive behaviours; high trust in government control measures could lead to passivity in individual response through behavioural change. In both Chinese and Italian respondents, higher scores of superstition and fatalism were also associated with less positive behavioural change. This agrees with previous literature suggesting that belief that health status is largely determined by external forces makes individuals less likely to adopt behaviours that can positively impact one's health outcomes. 10 Overall anxiety levels and adoption of positive behaviours were strongly influenced by information sufficiency in all three countries, showing that population-level risk perception, self-efficacy and response to an outbreak can be intensified or attenuated by the quantity and quality of information provided. 11, 12 These findings highlight the importance of disseminating authoritative information from trusted health and government authorities through a variety of online and traditional media outlets, especially during the initial phase of an outbreak. Clear information about signs and symptoms of the disease, risk reduction measures, protective behaviours and why specific control measures are being taken should be provided via these channels.