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Public behaviour during a pandemic

Authors:
  • Geneva Centre for Security Sector Governance
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The Australian Journal of Emergency Management, Vol. 23 No. 3, August 2008
Introduction
A pandemic resulting from a newly emerged disease
constitutes one of the more probable events likely
to threaten national security (Cecchine and Moore,
2006, Brower and Chalk, 2003). Like many countries,
Australia is currently taking steps to improve its ability
to manage an outbreak of pandemic. An important
component of these efforts to date is Exercise Cumpston1,
a multi-jurisdictional exercise held in October 2006.
Exercise Cumpston provided State and Federal
Government agencies an opportunity to validate
elements of their pandemic influenza management
plans. Moreover, it offered us a means by which to
test and, if necessary, refine the inter-departmental
coordination processes so critical to the effectiveness
of any response.
The plans developed by government agencies form
the first part of what we see as a two-part pandemic
management equation. The second part relates to the
public—specifically, how the public is likely to behave
should a pandemic occur. What is rarely discussed is
the dependency between these two parts. The quality
of an agency’s pandemic management plan will depend,
to a large degree, on the quality of the assumptions
it makes about how the public will respond. There
is little sense in assuming that people will seek help
from influenza assessment centres, for example, if the
prevailing public intention is to present at hospital
emergency departments. What must be recognised is
that plans themselves cannot ensure the public will do
the ‘right’ things. People will differ in their responses,
and the majority of people will react based on their best
understanding of the situation, an understanding that
will depend on what information they have and how
they interpret that information. Ultimately, the success
of the pandemic plans will depend on their ability to
predict the ways in which people will act in a pandemic.
This paper outlines a number of public response
issues for effective pandemic planning. These include
conforming to movement and quarantine regulations,
following health and medical advice, and staffing
‘essential worker’ roles. Our analysis of these issues
leads us to the key concept of compliance. We argue
that by better understanding the drivers of compliance,
communication strategies can be devised to benefit the
management plans of government agencies.
Movement restrictions
One of the fundamental methods of containing
a pandemic (and thereby slowing its spread) is
the imposition of restrictions on movement and
gatherings (WHO, 2005, Office of Health Protection,
2006). Restrictions can be placed on the movement
of the uninfected population at local, national and
international levels. At the local level, many pandemic
plans call for school closure along with more general
recommendations to avoid crowds (WHO, 2006).
At the national and international level, restrictions will
be placed on people’s capacities to move from one region
to another. As a global phenomenon, a pandemic would
bring about severe international movement restrictions.
A range of psychological and social factors will influence
the effectiveness of restrictions on movement. People
are motivated to contravene movement restrictions by a
strong desire to be with their families and community,
to protect their economic wellbeing, or even due to
their mistrust in the advice of the government.
The motivation to flee en masse can be driven by
anxiety and fear of contracting the disease. The plague
outbreak in Surat, India in 1994 led to the uncontrolled
flight of 600,000 people, including essential medical
staff (Ramalingaswami, 2001). The extent to which fear
and anxiety drive this sort of collective ‘panic’ will be
related in part to people’s beliefs about the effectiveness
of the government’s response. While panic is a highly
uncommon response to crisis (Auf der Heide, 2004)
there is a large amount of research showing people’s
unwillingness to modify their movements in the ways
that the authorities would prefer (Donner et al., 2007).
The public’s response to instructions is dependant on
a range of social and psychological factors (Mileti and
Sorensen, 1990).
Public behaviour during
a pandemic
Hagan, Maguire and Bopping outline a number of public response issues
for effective pandemic planning.
1 Exercise Cumpston was Australia’s largest health simulation exercise, testing preparedness for response to pandemic influenza. It served as a
comprehensive test of Australia’s National Pandemic Plan.
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The Australian Journal of Emergency Management, Vol. 23 No. 3, August 2008
Relating to this, there is mixed evidence for the
effectiveness of isolation measures in stopping the spread
of highly contagious diseases like influenza (WHO,
2006, Garrett, 2005). If such information questioning
their effectiveness becomes public knowledge, and the
availability of information in our culture suggests that
it will, we can expect it to affect people’s willingness to
comply with movement restrictions. At the national level
a lack of coordination in policy can lead to problems.
During the 1919 Influenza epidemic in Australia,
differences in State policies led to interstate tensions,
when States unilaterally implemented movement
controls to protect themselves (WHO, 2006). We can
expect modern media to immediately report on such
problems, and for awareness of this to affect people’s
attitudes and behaviour.
Quarantine
When a pandemic first emerges, we can expect that at
least its first victims will be quarantined in hospitals.
As it develops, victims may also be quarantined at
home (Cava et al., 2005b, CDC, 2007, Office of
Health Protection, 2006). Any new influenza virus
has unique characteristics and it takes time to develop
an understanding of how it is transmitted and when
protective measures need to be taken. In particular, it is
well understood that it will take between 4 to 6 months
to develop effective vaccines (CDC, 2007).
While Australians are familiar with the rationale and
value of quarantine of diseases and pests in order to
protect Australia’s natural environment and industry,
they are unfamiliar with quarantine of people. Evidence
from several previous quarantine efforts indicates
that compliance is mixed (WHO, 2006). Even where
compliance is reportedly high, as it was during the
SARS crisis, compliance within households was far less
effective than general public compliance (Hawryluck et
al., 2004). People were willing to remain quarantined at
home, especially as they were encouraged to do so by
social pressure. However within their home they ignored
health protocols (such as wearing a mask) where they
found the requirement questionable or burdensome
(Cava et al., 2005b).
Evidence suggests that being quarantined has a
psychological effect on an individual. Hawryluck and
colleagues (2004) found that both being quarantined
and being acquainted with a quarantined individual
were associated with high levels of symptoms indicative
of post traumatic stress disorder. Longer duration of
quarantine was also associated with greater distress
symptoms. This suggests that during a pandemic the
process of quarantine itself will contribute a significant
psychological burden on the community.
As with movement restrictions, adherence to quarantine
will be strongly influenced by its perceived effectiveness.
Quarantine worked well during SARS because of
the low transmissibility and delay in peak infectivity
(Skowronski et al., 2006). As such, the population was
willing to comply with instructions. It also helped that
the numbers quarantined, while large, were still small
enough for compliance with the orders to be checked
on a regular basis by health professionals (Cava et al.,
2005a). The work load on health workers during a
pandemic may make this type of individual monitoring
impractical. When a highly transmissible disease
(like influenza) emerges, many experts believe
quarantine will be ineffective (WHO, 2006). If this
doubt becomes public, a consequence may be that
people are likely to be less willing to comply. The rapid
transmission of information in modern society suggests
that awareness of these doubts will spread quickly through
the population if the crisis response suffers setbacks.
Health/medical instructions
An effective pandemic response requires people to
comply with precautionary health measures. People
will be required to recognise their own (or their family
members’) symptoms, and to follow certain instructions
based on these symptoms. People will be required
to make the judgment on when they should attend
hospital, and when they should administer self-care at
home. Self-care measures may include wearing masks,
washing hands, avoiding contact with infected people,
taking prescribed medication and not taking non-
prescribed medications.
It is accepted that many of the people who arrive at
hospitals during a pandemic will be there due to their
distress and illusory symptoms, rather than actual
infection (Reissman et al., 2006). These self-referrals for
screening and admission increase the risk of hospital
cross-infection (Wong et al., 2004). They also add to
the burden on the health care system (e.g., by flooding
triage and emergency wards).
People will also try to get access to drugs regardless
of their actual need for them. In India, during
the 1994 plague outbreak, supplies of the drug
tetracycline (believed to be effective against the disease)
were unavailable after widespread public buying
(Ramalingaswami, 2001).
Alternatively, the public may also refuse to use drugs
if they fear that they have been given incomplete
information regarding particular medication. Concern
about side effects may outweigh the fear of not taking
the medication and of contracting the disease. Public
confidence in the United States government plummeted
after hasty adoption of a widespread ‘swine flu’
vaccination program (Enemark, 2007, Thomas, 2007).
The virus only killed one person, and never became an
epidemic. The vaccine that was given to halt a possible
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The Australian Journal of Emergency Management, Vol. 23 No. 3, August 2008
epidemic resulted in hundreds of people hospitalised
after adverse reactions, and more than 20 deaths.
This outcome did considerable damage to the CDC’s
reputation, endangering future public cooperation
(Thomas, 2007). As WHO regard the timely use of
antiviral drugs as vital to containing a pandemic, such
non-compliance could increase the scale of the disaster
significantly (WHO, 2005).
Pandemic planning must recognise that we cannot
assume that people will comply with health and medical
instructions. It is likely that there will be low levels of
compliance with any public health recommendations
(Reissman et al., 2006). During the SARS crisis, even
doctors were inconsistent in complying with basic
hygiene measures (Wong et al., 2004). Wong et al.
(2004) attribute this to the fact that the doctors had
no experience or understanding of the disease, and no
clear knowledge of its infectiousness. Clearly the public
will have an even more limited comprehension of the
infection, and may not understand the importance of
certain measures. However understanding alone will
not be enough to guarantee compliance, as social and
psychological factors will influence people’s response
to instructions even if they understand the reasons for
those instructions (Mileti and Sorensen, 1990).
Essential workers
Government pandemic plans focus on ensuring that
hospitals are well equipped and supplied to deal
effectively with affected individuals, and on keeping
other essential services operating. Essential sectors
include health, law and order, defence, electricity
and water, telecommunications, banking and finance,
and food supply. However, in order for hospitals and
other services to function effectively, it is necessary
to have people to operate and work in them. We can
question whether doctors, nurses, and other essential
workers will continue to work during a pandemic.
Most of the evidence about behaviour during disease
type crisis events has been collected on health workers.
The refusal of healthcare workers (and workers more
generally) to attend work is likely to be motivated by a
fear of risk to themselves and to their families (McNeil,
2003). This fear will be fuelled by uncertainty about
the mode of transmission of the disease and about
appropriate protective measures. The public may also
see certain people as potential threats as a result of their
occupation (e.g., healthcare workers exposed to infected
patients) and stigmatisation may arise in response.
With continued contact with infected patients,
healthcare workers are likely to be at increased risk of
becoming ill. During the SARS crisis, doctors, nurses
and other healthcare workers were among the first
affected (Abraham, 2005). Many general practitioners
in Hong Kong changed their consulting behaviour,
potentially affecting the standard of care delivered
(Wong et al., 2004). A smaller number went so far as
to close their clinics after a suspected SARS case.
The outbreak of SARS in Taiwan led to mass resignations
of medical staff, especially the poorer paid nurses
(McNeil, 2003).
With such a threat, and with the fear that comes from
uncertainty, it is reasonable to expect a proportion
of healthcare workers to refuse to attend work. To
minimise this it will be necessary for healthcare and
other essential workers to be included in pandemic
planning, and to ensure that they receive information
about risks and about the protective measures that can
be taken (Kotalik, 2005). An important first step has
recently been taken in Australia with the release of the
online pandemic planning tool for GPs2.
As a pandemic spreads to a significant percentage of the
population, such that any social situation is a potential
threat, the above effects are unlikely to remain restricted to
health workers. Workers in all the essential sectors can feel
threatened, and may adjust their behaviour to minimise
this threat. Given the dependency of modern life on
basics, such as electricity and immediate communications,
the ability of a full range of essential services to maintain
staff numbers is of critical importance.
Compliance
As this paper has discussed, priority issues in pandemic
planning include movement restrictions, quarantine,
adherence to health and medical instructions, and
staffing of essential roles. Common to each of these
priority issues is the notion of compliance. Compliance
may be defined as changing behaviour as expected
or requested. The psychological description of the
compliance process involves communication (a request)
and a response (acquiescence) (Cialdini and Goldstein,
2004). Research on compliance has generally focused
on questions of when and why people will comply.
There is a large literature on the problems in
encouraging compliance through communications
during a crisis (Mileti and Sorensen, 1990, Donner
et al., 2007). Compliance has also been extensively
studied in the medical literature, in the context of when
people will or will not follow drug regimens. Within
the psychological literature several factors have been
identified that influence compliance, a subset of which
may be amenable to manipulation during a crisis:
• Authority
• SocialValidation
• Consistency
• Reciprocity
2 http://info.anu.edu.au/mac/Media/Media_Releases/_2007/_April/_030407_influenzaonlinetool.asp?p=1
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The Australian Journal of Emergency Management, Vol. 23 No. 3, August 2008
An awareness and understanding of these factors
will help governments and authorities increase the
compliance of the population with requests made
during a pandemic.
Authority
People are more willing to accede to the request of
a legitimate authority (Cialdini, 1988, Mileti and
Sorensen, 1990, Donner et al., 2007). Compliance
is more likely to occur when the person making the
request is seen as the appropriate authority to be acting
in the particular situation. In terms of a pandemic,
it is encouraging that Exercise Cumpston included
government officials up to and including the Prime
Minister, as national-level requests are more likely
to be complied with when presented by the highest
authority. During a pandemic, the other component of
legitimate authority will be medical knowledge. Simple
things like the use of the title “Doctor” may influence
people’s compliance with instructions, as people see
the medical advice as coming from a knowledgeable
source. If counter-claims about the effectiveness of
pandemic response measures also come from medical
authorities, the legitimate authority will be questioned
and compliance will be reduced.
Social validation
People get information about how to behave by looking
to the behaviour of others, particularly those in the same
social group (Reno et al., 1993). This is particularly
true in uncertain situations—notably in crisis situations
(Cialdini, 1988). In the floods in Grafton in 2001,
for example, those who were uncertain about whether
to evacuate or not looked to see what their neighbours
were doing (Pfister, 2002). If their neighbours were
not evacuating, they also failed to evacuate. In this way,
non-compliance encourages further non-compliance.
Compliance can be increased by minimising the
uncertainty, but primarily by emphasising that the
social group’s response is to comply.
Consistency
People will behave consistently with their previous
behaviour. For example, if they failed to evacuate
for a previous flood (and there were no adverse
consequences), it is likely that they will also not
evacuate for a later flood. Thus the decision for non-
compliance, if it does not result in bad outcomes,
will encourage non-compliance to similar demands.
This effect will occur even when the specific threat is
greater, and the likelihood of negative outcomes larger,
in the second incident. Consistency can also work to
increase compliance, if the public’s behaviour can be
shaped. Cialdini and Goldstein (2004) describe the
foot-in-the-door technique for enhancing compliance,
which involves making a small request, obtaining
compliance and then making a second, larger (related)
request. Once the person has agreed to the first request,
they are more likely to comply with the second (larger
request). Turning this tendency into an action applicable
to pandemic planning would require some creativity,
however it may be possible to leverage the consistency
bias in some situations.
Reciprocity
People feel obliged to repay others for what we have
received from them (Cialdini, 1988, Gueguen and
Pascual, 2003). One of the ways of encouraging
compliance is to give something to the target, thus
creating in them the obligation to give something in
return. Medical workers in Taiwan, Singapore and China
received bonuses and preferential treatment during the
SARS crisis, specifically to encourage them to continue
to work despite the threat to their person and family
(McNeil, 2003, Wiskow, 2003). Reciprocity can also be
activated using the door-in-the-face technique, which
involves asking a large request then retreating to offer
a smaller request (the intended request). Compliance is
explained by the person’s feeling of obligation to accept
the smaller request as reciprocation for the requester’s
concession. This has been found to have a strong effect
on behaviour, even in naturalistic settings (Pascual and
Gueguen, 2006).
Communication
The primary leveraging/driving factor that government
bodies will have to encourage compliance is
communication. Effective communication with the
public is essential for ensuring compliance with
instructions given and restrictions imposed during a
response. To foster trust of authorities, effective
Media can assist in disseminating information to the public
during a pandemic.
© Newspix
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The Australian Journal of Emergency Management, Vol. 23 No. 3, August 2008
communication is important before, during and after
a pandemic. Figure 1 shows a conceptualisation of the
role of communication and compliance.
While it is necessary to find a balance between
informative communication and panic-inducing
communication (Enemark, 2006), the public will
demand timely and comprehensive information
regarding what is happening, what they need to do—
and why (Donner et al., 2007, Mileti and Sorensen,
1990). If people are less uncertain about what is
happening and what they need to do, they are less
likely to turn to others to get a sense of the appropriate
behaviour (i.e. less need for social validation). Adequate
information can be used to discriminate the current
situation from previous ones, undermining the
consistency effect where it encourages non-compliance.
Similarly, if information is not complete, the public may
lose faith in the government as an authority (Enemark,
2006, Penfield and Larkin, 2006) and rely on rumour
systems and unofficial media reports. Indeed, Kotalik
(2005) argues that a concern for public panic is an
insufficient reason for failing to communicate unfolding
events to the public.
By better understanding the drivers of compliance,
communication strategies can be devised to benefit
the management plans of government agencies.
Communication is not the only option available,
although it may be the simplest to apply with limited
planning. Communication will be the primary factor
deciding the success of using authority and social
validation to encourage compliance. In the factors
of consistency and reciprocity there remains greater
potential for government agencies to implement
creative crisis response strategies designed to
maximise compliance.
References
Abraham, T. (2005) Twenty-first Century Plague: The Story
of SARS, Baltimore, John Hopkins University Press.
Auf Der Heide, E. (2004) Common misconceptions
about disasters: panic, the “disaster syndrome”, and
looting. IN O’LEARY, M. (Ed.) The First 72 Hours: A
Community Approach to Disaster Preparedness. Lincoln,
Nebraska, iUniverse Publishing.
Brower, J. & Chalk, P. (2003) The Global Threat of
New and Reemerging Infectious Diseases: Reconciling U.S.
National Security and Public Health Policy, Santa Monica,
RAND Corporation.
Cava, M. A., Fay, K. E., Beanlands, H. J., McCay, E. A. &
Wignall, R. (2005a) The Experience of Quarantine for
Individuals Affected by SARS in Toronto. Public Health
Nursing, 22, 398-406.
Cava, M. A., Fay, K. E., Beanlands, H. J., McCay, E. A.
& Wignall, R. (2005b) Risk Perception and Compliance
with Quarantine During the SARS Outbreak. Journal of
Nursing Scholarship, 37, 343-347.
CDC (2007) CDC Influenza Pandemic Plan (OPLAN).
Centres for Disease Control and Prevention.
Cecchine, G. & Moore, M. (2006) Infectious Disease
and National Security: Strategic Information Needs, Santa
Monica, RAND Corporation.
Figure 1: Psychological factors and social issues in pandemic planning.
Communication
Leveraging Factor Psychological factors Central Factor Priority Issues
Authority
Social
Validation
Consistency
Reciprocity
Compliance Movement restrictions
Quarantine
Health & medical
instructions
Staffing essential roles
A quarantine isolation unit.
© Newspix
40
The Australian Journal of Emergency Management, Vol. 23 No. 3, August 2008
Cialdini, R. B. (1988) Infuence: Science and Practice,
Glenview, Scott, Foresman and Company.
Cialdini, R. B. & Goldstein, N. J. (2004) Social
Influence: Compliance and Conformity. Annual Review
of Psychology, 55, 591-621.
Donner, W. R., Rodriguez, H. & Diaz, W. (2007)
Public Warning Response Following Tornadoes in
New Orleans, LA, and Springfield, MO: A Socialogical
Anaysis. Second Symposium on Policy and Socio-economic
Research. San Antonio, Texas.
Enemark, C. (2006) Pandemic pending. Australian
Journal of International Affairs, 60, 43-49.
Enemark, C. (2007) Pandemic Influenza and National
Security. Australian Defence Force Journal, 171, 18-32.
Garret, L. (2005) The Next Pandemic? Foreign Affairs,
84, 3-23.
Gueguen, N. & Pascual, A. (2003) Reciprocity and
Compliance to a Request: An Experimental Evaluation
in a Natural Setting. Psychology and Education: An
Interdisciplinary Journal, 40, 16-19.
Hawryluck, L., Gold, W. L., Robinson, S., Pogorski,
S., Galea, S. & Styra, R. (2004) SARS Control and
Psychological Effects of Quarantine, Toronto, Canada.
Emerging Infectious Diseases, 10, 1206-1212.
Kotalik, J. (2005) Preparing for an Influenza Pandemic:
Ethical Issues. Bioethics, 19, 422-431.
McNeil, D. G. (2003) SARS Fears Shake Taiwan Medical
Staffs. The New York Times. New Your.
Mileti, D. S. & Sorensen, J. H. (1990) Communication
of Emergency Public Warnings: A Social Science
Perspective and State-of-the-Art Assessment. Washington
DC, Federal Emergency Management Agency.
Pascual, A. & Gueguen, N. (2006) Door-in-the-Face
Technique and Monetary Solicitation: An Evaluation in a
Field Setting. Perceptual and Motor Skills, 103, 974-978.
Penfield, S. & Larkin, J. (2006) Avian Flu: A Test of
Collective Integrity. Strategy + Business, 43, 1-5.
Pfister, N. (2002) Community Response to Flood
Warnings: The Case of an Evacuation from Grafton,
March 2001. Australian Journal of Emergency
Management, 17, 19-29.
Protetction, O. O. H. (2006) Australian Health
Management Plan for Pandemic Influenza. IN DOHA
(Ed.), Commonwealth of Australia.
Ramalingaswami,V.(2001)PsychosocialEffectsofthe
1994 Plague Outbreak in Surat, India. Military Medicine,
166, 29-30.
Reissman, D. B., Watson, P. J., Klomp, R. W., Tanielian,
T. L. & Prior, S. D. (2006) Pandemic Influenza
Preparedness: Adaptive Responses to an Evolving
Challenge. Journal of Homeland Security and Emergency
Management, 3, 1-28.
Reno, R. R., Cialdini, R. B. & Kallgren, C. A. (1993)
The Transsituational Influence of Social Norms. Journal
of Personality and Social Psychology, 64, 104-112.
Skowronski, D. M., Petric, M., Daly, P., Parker, T. A.,
Bryce, E., Doyle, P. W., Noble, M. A., Roscoe, D. L.,
Tomblin, J., Yang, T. C., Kraiden, M., Patrick, D. M.,
PourbohloulL, B., Goh, S. H., Bowie, W. R., Booth, T.
L., McGeer, A. & Brunhem, R. C. (2006) Coordinated
ResponsetoSARS,Vancouver,Canada.Emerging
Infectious Diseases, 12, 155-158.
Thomas, J. C. (2007) Ethical Concerns in Pandemic
Influenza Preperation and Responses. Southeast Regional
Centre of Excellence for Emerging Infectious and
Biodefence.
WHO (2005) Responding to the Avian Influenza
Pandemic Threat. World Health Organisation.
WHO (2006) Nonpharmaceutical Interventions
for Pandemic Influenza, National and Community
Measures. Emerging Infectious Diseases, 12, 88-94.
Wiskow, C. (2003) The Impact of Severe Acute
Respiratory Syndrome (SARS) on Health Personnel.
International Labour Office.
Wong, W. C. W., Lee, A., Tsang, K. K. & Wong, S.
Y. S. (2004) How did General Practitioners Protect
Themselves, their Families, and Staff During the SARS
Epidemic in Hong Kong? Journal of Epidemiology and
Community Health, 58, 180-185.
About the authors
Dr Patrick Hagan works for the Defence Science and
Technology Organisation (DSTO), as part of the Crisis
Management Improvement (CMI) team. He holds a PhD in
Experimental Social Psychology from the University of Western
Australia and currently leads the CMI team’s research program
on social resilience. Email: patrick.hagan@dsto.defence.gov.au
Brigit Maguire has worked at the Defence Science and
Technology Organisation as part of the Crisis Management
Improvement team and is currently studying to complete
her honours in Social Psychology at the Australian National
University.
Dr Derek Bopping has a PhD in Social Psychology from the
Australian National University. He has worked for the Defence
Science and Technology Organisation, as part of the Crisis
Management Improvement team and previously led the CMI
team’s social resilience research program.
R
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The outbreak of the COVID‐19 pandemic has plunged the world into a crisis. To contain the crisis, it is essential to build full cooperation between the government and the public. However, it is unclear which governmental and individual factors are the determinants and how they interact on protective behaviors against COVID‐19. To resolve this issue, this study built a multiple mediation model and found government emergency public information as detailed pandemic information and positive risk communication had more important impacts on protective behaviors than rumor refutation and supplies. Moreover, governmental factors could indirectly affect protective behaviors through individual factors such as perceived efficacy, positive emotions, and risk perception. These findings suggest that systematic intervention programs for governmental factors need to be integrated with individual factors to finally achieve effective prevention and control of the COVID‐19 pandemic among the public. This article is protected by copyright. All rights reserved.
... In this model, government emergency public information is considered to be the source of information, and the individual's emotional and cognitive perception and consideration are considered to be an extension of perceptions in the PADM model. Additionally, protective behaviors, including preventive behaviors (i.e., wearing masks, disinfectants) (Kim et al. 2015), avoidant behaviors (i.e., stringent quarantine, avoiding public places) (Bayham et al. 2015), and management of disease behaviors (i.e., seeking professional protection or treatment information, paying for preventive and therapeutic drugs) (Hagan, Maguire, and Bopping 2008), are considered to be the actions (Bish and Michie 2010). One important issue that should be explored is how government emergency public information can persuade the public to adopt recommended protective behaviors to control the spread of COVID-19. ...
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The outbreak of the COVID-19 pandemic has plunged the world into a crisis. To contain the crisis, it is essential to build full cooperation between the government and the public. However, it is unclear which governmental and individual factors are the determinants and how they interact on protective behaviors against COVID-19. To resolve this issue, this study built a multiple mediation model and found government emergency management as information transparency and positive propaganda had more important impacts on protective behaviors than refuting rumors and supplies. Moreover, governmental factors could indirectly affect protective behaviors through individual factors such as perceived control, positive emotions, and risk perception. These findings suggest that systematic intervention programs for governmental factors need to be integrated with individual factors to finally achieve effective prevention and control of the COVID-19 pandemic among the public.
... The success of the pandemic management plan in Australia depends critically on public compliance with health measures (5,6). A study completed in 2007 found that a high proportion of respondents reported willingness to accept a range of public health measures (although the scenario provided in that study was a more severe pandemic) (7). ...
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