Abstract

Introduction

On 31 December 2019, Chinese authorities notified the WHO of an outbreak of pneumonia in Wuhan City, which was later classified as a new disease: COVID-19.1 Following identification of cases in countries outside China, on 30 January 2020, the WHO declared the outbreak of COVID-19 a ‘Public Health Emergency of International Concern’.1 In the UK, the first cases of COVID-19 were diagnosed at the end of January 2020, and community transmission was reported a few weeks later.2 3 Government measures to control the epidemic were first announced on 22 January 2020 and included travel advice, information for those returning from affected countries, testing of suspected cases, isolation and contact tracing. This was followed in early February by a public health information campaign advising people to adopt hygiene measures to protect themselves and others, including more frequent handwashing with soap and water, using hand sanitiser if soap and water are not available, and covering mouth and nose with a tissue or sleeve when coughing or sneezing.4 Then, on 3 March 2020, the UK Government published its action plan setting out the UK-wide response to the novel coronavirus. The UK Government’s response outlined measures in four key areas: containing the outbreak, delaying its spread, mitigating the impact, and research to improve diagnostics and treatment.5

On 16 March 2020, 5days after the WHO declared the outbreak of COVID-19 a pandemic, the UK Prime Minister announced a shift to the delay phase of the UK response with measures aimed at suppressing the spread of the infection in the population through non-pharmaceutical interventions (NPIs), including social distancing of the whole population, isolation of cases for 7 days and quarantine of their household members for 14 days.6 The public was advised to stop non-essential contact with others and all unnecessary travel: including working from home where possible and avoiding pubs, theatres, restaurants and other social venues.6 This shift in response was prompted by a mathematical modelling study which showed that a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members (and possible school and university closure) was required to suppress transmission to a level that would enable the National Health Service to cope with the surge in cases requiring hospital admission and ventilation.7

The effect of NPIs to reduce transmission rates is dependent on compliance with public health advice on social distancing. In the initial stages of the UK epidemic, this advice was voluntary, and not enforced by the government. This was criticised due to concern that measures may not have the desired impact if a significant proportion of the population were unable or unwilling to comply.

Protective behaviours are not uniformly adopted throughout a population during an epidemic. Evidence from influenza outbreaks suggests that women are more likely to adopt NPIs than men.8 9 In the UK, during the H1N1 pandemic, non-white ethnic groups were more likely to adopt hygiene and social distancing behaviours compared with white.10 11 Employment status has also been associated with NPI adoption.12 13 Evidence from Australia during the H1N1 pandemic found those who were self-employed and who were unable to work from home were most likely to report intentions to not comply with preventative measures,13 suggesting that without support, it may be challenging for individuals who are unable to work from home to comply with certain public health recommendations. During the current COVID-19 pandemic, public risk perceptions and knowledge have been explored in various countries.14–20 However, only a few have identified the factors associated with greater adoption of preventative measures, or how these associations vary by context. In Hong Kong, both greater understanding of COVID-19 and increased anxiety were associated with greater adoption of social distancing behaviours.18

As such, this study aimed to assess reported behaviour and intention to comply with the NPIs, as recommended by the UK Government at the time of the survey. Preliminary findings were shared with the Scientific Advisory Group for Emergencies, which advises the UK Government’s response to COVID-19.21

Methods

Results

The overall sample is described in table 1. There was lower response among people from minority ethnic groups and older age groups compared with the UK population profile (online supplemental file S1 for full details of the sample profile compared with UK population profile). In summary, of the 2108 respondents, 11.1% were 18–24 years old, and 13.5% were 70 years or older. The majority of respondents were white (93.9%). In total, 43.4% were in full-time work and 14.1% were in part-time work.

Table 1

Demographics, socioeconomic characteristics and COVID-19 risk perceptions, N=2108

Characteristic	No	Weighted %
Demographic and socioeconomic
Age (years)
18–24	218	11.1
25–34	294	14.4
35–44	396	19.3
45–54	355	17.5
55–69	519	24.2
70 or above	326	13.5
Sex
Male	987	48.0
Female	1094	50.7
Prefer not to say	27	1.3
Ethnicity
White group	1985	93.9
Asian/Asian British	48	2.4
Black/African/Caribbean/Black British	20	1.0
Other ethnic group, including mixed/multiple ethnic groups	39	1.9
Prefer not to say	16	0.77
Marital status
Married, civil partnership or living as married	1283	60.3
Separated, divorced or widowed	270	12.2
Never married	545	27.1
Prefer not to say	10	0.45
Area of residence
London	239	13.1
North	522	23.3
Midlands	531	25.2
South	485	22.5
Northern Ireland, Scotland, Wales	331	15.9
Education
No formal qualification	121	5.5
Secondary-level qualification	859	42.1
Post-secondary level, below bachelor	148	6.9
Bachelor level or above	664	30.8
Other technical, professional or higher qualification	245	11.2
Don’t know	32	1.6
Prefer not to say	39	2.0
Employment status
Working full time	889	43.4
Working part time	292	14.1
Full-time student	112	5.6
Retired	553	23.6
Unemployed or not working	207	10.5
Other	55	2.8
Household income
<£20000	440	20.7
£20000–£29999	355	16.8
£30 000–£49999	472	22.4
£50000 and over	429	20.6
Don’t know	103	5.1
Prefer not to say	309	14.4
Savings
Less than £100	278	13.6
£100–£999	242	11.8
£1000–£4999	305	14.5
£5000–£24999	359	16.6
£25000 or more	359	16.6
Prefer not to say	565	26.9
Housing tenure
Own—outright	681	30.4
Own—mortgage/shared ownership	639	30.8
Rent—private landlord	319	15.6
Rent—local authority/housing association	219	10.7
Live with parents, family or friends	215	10.7
Other	35	1.8
COVID-19 risk perceptions
Level of worry about the current COVID-19 outbreak in the UK
Worried	1640	77.4
Not worried	454	21.9
Don’t know	14	0.74
Perceived susceptibility*
Likely	979	47.5
Neither likely or unlikely	547	26.2
Unlikely	337	15.9
Don’t know	220	10.5
Perceived severity†
I would expect it to be life-threatening	103	4.7
I would expect it to be severe (eg, may need care and treatment in hospital)	306	14.2
I would expect it to be moderate (eg, may need self-care and rest in bed)	1180	56.9
I would expect it to be mild (eg, can go about daily tasks normally)	351	17.2
I would expect to have no symptoms	33	1.7
Don't know	110	5.3

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*Under the UK government’s current preventive measures (at the time of the study), how likely or unlikely do you think it is you will be infected with the coronavirus (COVID-19) at any point in the future?

†Please imagine you were infected with coronavirus (ie, COVID-19), which of the following do you think would best apply?

Overall, 77.4% (1640/2108) of respondents reported being worried about the COVID-19 outbreak in the UK. None of the 2108 respondents had previously tested positive for COVID-19, and 47.5% (979/2108) believed that it was likely they would be infected at some point in the future under the UK Government’s preventive measures. If infected, just over half (56.9%) of respondents would expect to be moderately severely affected (eg, may need self-care and rest in bed) (table 1).

Accordingly, 94.2% of adults reported taking at least one preventive measure (to protect oneself and others) against COVID-19 infection: 85.8% washed their hands with soap more frequently; 56.5% avoided crowded areas; 54.5% avoided social events and 39.2% avoided public transport (figure 1). Most reported that their behavioural change was in response to government guidance (71.3%). Preventive measures perceived to be most effective were washing hands more frequently with soap and water (92.5%), avoiding contact with people who have a fever or respiratory symptoms (91.4%), and covering nose and mouth when sneezing or coughing (90.0%) (figure 1). Perceived effectiveness of preventive measures was higher than actual adoption for all measures. This was particularly marked for social distancing measures (figure 1).

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Figure 1

Perceived effectiveness and actual adoption of preventative measures to prevent transmission of COVID-19; N=2108.

Adoption of social distancing measures

Overall, 45.2% of respondents reported adopting social distancing measures (avoiding crowded places and avoiding social events) to protect themselves or others from COVID-19.

Table 2 shows the regression analysis results for adoption of social distancing measures. Being 70 years or older (64.2% vs 38.4%; aRR: 1.2; 95%CI: 1.1 to 1.5) was positively associated with greater adoption compared with younger adults aged 18–34 years. Compared with those who were married, in a civil partnership or living as married (48.4%), respondents who were separated, divorced or widowed (44.1%; aRR: 0.75; 95%CI: 0.64 to 0.87) or never married (38.4%; aRR: 0.74; 95%CI: 0.63 to 0.88) were less likely to have adopted social distancing measures to prevent transmission of COVID-19. Respondents with £100 savings or less were one-fifth less likely to have adopted social distancing measures compared with those with £25000 or more in savings (43.5% vs 48.4%; aRR: 0.83; 95%CI: 0.73 to 0.95) (table 2).

Table 2

Social distancing behaviour and ability to work from home by a range of sociodemographic factors, N=2108

	Social distancing measures being taken yes versus no*				Able to work from home yes versus no (N=1149)†
	N	Weighted %	Unadjusted RR (95%CI)	Adjusted RR (95%CI)	N	Weighted %	Unadjusted RR (95%CI)	Adjusted RR (95%CI)
Social distancing
Yes	969	45.2
No	1139	54.8
Ability to work from home
Yes					540	44.3
No					609	53.0
Don’t know					32	2.7
Age (years)
18–34	202	38.4	Ref	Ref‡	154	48.0	Ref	Ref§
35–49	229	40.8	1.1 (0.91 to 1.2)	0.86 (0.74 to 1.0)	220	48.0	1.0 (0.86 to 1.2)	0.98 (0.94 to 1.3)
50–69	329	46.4	1.2 (1.1 to 1.4)**	0.81 (0.73 to 1.0)	151	39.9	0.83 (0.70 to 0.99)*	0.90 (0.81 to 1.1)
70 or older	209	64.2	1.7 (1.5 to 1.9)***	1.2 (1.1 to 1.5)*	15	53.9	1.1 (0.78 to 1.6)	1.1 (0.96 to 1.7)
Sex
Male	436)	42.9	Ref	Ref‡	280	46.1	Ref	Ref§
Female	519	47.4	1.1 (1.0 to 1.2)*	1.0 (0.88 to 1.2)	254	44.8	0.97 (0.85 to 1.1)	0.98 (0.86 to 1.2)
Ethnicity
White group	919	45.5	Ref	–	506	45.1	Ref	Ref§
Black, Asian and minority ethnic	45	42.1	0.92 (0.73 to 1.2)		31	54.2	1.2 (0.94 to 1.5)	1.0 (0.98 to 1.1)
Marital status
Married, civil partnership or living as married	628	48.4	Ref	Ref‡	366	47.2	Ref	–
Separated, divorced or widowed	121	44.1	0.91 (0.79 to 1.1)	0.75 (0.64 to 0.87)***	43	39.5	0.84 (0.65 to 1.1)
Never married	214	38.4	0.79 (0.70 to 0.90)***	0.74 (0.63 to 0.88)**	128	43.5	0.92 (0.79 to 1.1)
Area of residence
London	111	45.2	Ref	–	76	54.0	Ref	Ref§
North of England	220	41.6	0.92 (0.77 to 1.1)		129	44.7	0.83 (0.67 to 1.0)	1.0 (0.76 to 1.2)
Midlands and East of England	249	46.0	1.0 (0.86 to 1.2)		123	44.4	0.82 (0.67 to 1.0)	1.0 (0.75 to 1.1)
South of England	221	45.0	0.99 (0.84 to 1.2)		151	49.0	0.91 (0.75 to 1.1)	1.0 (0.88 to 1.4)
Northern Ireland, Scotland, Wales	168	49.9	1.1 (0.92 to 1.3)		61	35.2	0.65 (0.50 to 0.84)**	0.76 (0.59 to 1.0)
Education
Degree or above	321	48.0	Ref	–	289	62.6	Ref	Ref¶
Post-secondary	186	46.7	0.97 (0.85 to 1.1)		105	47.7	0.76 (0.65 to 0.89)**	0.68 (0.59 to 0.79)***
Secondary or below	436	43.7	0.91 (0.82 to 1.0)		137	29.4	0.47 (0.40 to 0.55)***	0.45 (0.39 to 0.53)***
Employment status
Working full time	344	38.6	Ref	Ref‡	439	48.9	Ref	Ref¶
Working part time	136	46.8	1.2 (1.0 to 1.4)*	1.0 (0.86 to 1.2)	101	35.0	0.71 (0.60 to 0.85)***	0.93 (0.84 to 1.2)
Full-time student	43	36.3	0.94 (0.73 to 1.2)	1.0 (0.71 to 1.5)	N/A	N/A	N/A	N/A
Retired	331	59.7	1.5 (1.4 to 1.7)***	1.1 (0.90 to 1.3)	N/A	N/A	N/A	N/A
Unemployed/not working	95	45.4	1.2 (0.99 to 1.4)	1.1 (0.90 to 1.4)	N/A	N/A	N/A	N/A
Household income
£50000 and over	178	41.0	Ref	Ref**	241	67.3	Ref	Ref††
£30000–£49999	211	43.8	1.1 (0.92 to 1.2)	1.0 (0.87 to 1.2)	131	42.6	0.63 (0.54 to 0.74)***	0.55 (0.47 to 0.63)***
£20000–£29999	173	48.5	1.2 (1.0 to 1.4)*	1.1 (0.89 to 1.3)	64	30.7	0.46 (0.37 to 0.57)***	0.41 (0.33 to 0.52)***
<£20 000	218	49.0	1.2 (1.0 to 1.4)*	1.0 (0.87 to 1.2)	31	22.7	0.34 (0.24 to 0.47)***	0.33 (0.24 to 0.45)***
Savings
£25000 or more	177	48.4	Ref	Ref**	100	59.9	Ref	Ref††
£5000–£24999	177	48.7	1.0 (0.86 to 1.2)	1.1 (0.93 to 1.3)	131	57.6	0.96 (0.81 to 1.1)	0.90 (0.76 to 1.1)
£1000–£4999	126	40.7	0.84 (0.71 to 1.0)	0.76 (0.67 to 0.87)***	89	43.7	0.73 (0.59 to 0.90)**	0.67 (0.54 to 0.83)***
£100–£999	91	37.4	0.77 (0.63 to 0.94)*	0.73 (0.61 to 0.87)***	67	40.1	0.67 (0.53 to 0.84)**	0.64 (0.50 to 0.81)***
Less than £100	122	43.5	0.90 (0.76 to 1.1)	0.83 (0.73 to 0.95)***	54	33.1	0.55 (0.43 to 0.71)***	0.51 (0.39 to 0.67)***
Housing tenure
Own outright	377	55.0	Ref	Ref**	93	41.0	Ref	Ref††
Own with mortgage/shared ownership	261	40.8	0.74 (0.66 to 0.83)***	0.95 (0.82 to 1.1)	293	55.0	1.3 (1.1 to 1.6)**	1.0 (0.73 to 1.5)
Rented from private landlord	145	45.0	0.82 (0.71 to 0.94)**	1.1 (0.90 to 1.3)	85	39.8	0.97 (0.77 to 1.2)	0.92 (0.83 to 1.1)
Rented from local authority/housing association	94	42.2	0.77 (0.65 to 0.91)**	0.90 (0.75 to 1.1)	16	18.2	0.44 (0.27 to 0.72)**	0.45 (0.28 to 0.73)**
Live with parents, family or friends	78	35.4	0.64 (0.53 to 0.78)***	0.93 (0.70 to 1.2)	46	43.6	1.1 (0.81 to 1.4)	0.79 (0.65 to 1.0)

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*P<0.05, **p<0.01, ***p<0.001.

*Those that report avoiding crowded areas and social events.

†Excluding those who responded ‘Don’t know’.

‡Mutually adjusted for age, sex, marital status, employment status, household income, savings and housing tenure.

§Mutually adjusted for age, sex, ethnicity, UK area of residence, education, employment status, household income, savings and housing tenure.

¶Adjusted for age, sex, ethnicity, UK area of residence and housing tenure.

**Adjusted for age, sex, marital status and employment status.

††Adjusted for age, sex, ethnicity and UK area of residence.

N/A, not available; RR, relative risk.

Willingness and ability to self-isolate

Overall, perceived ability (87.0%) and willingness (87.6%) to self-isolate for 7 days if asked by a healthcare professional were high.

In terms of sociodemographic associations, there was no effect of sex on perceived ability to self-isolate (table 3). However, women were somewhat more willing to do so than men (94.9% vs 91.8%; aRR: 1.1; 95%CI: 1.0 to 1.2). Respondents from ethnic minority backgrounds perceived themselves to be less able to self-isolate than respondents from white backgrounds (84.8% vs 92.1%, aRR: 0.89; 95%CI: 0.79 to 1.0), although they were equally willing to do so (table 3).

Table 3

Ability and willingness to self-isolate by sociodemographic factors

	Able to self-isolate yes versus no (N=2002)*				Willing to self-isolate yes versus no (N=1978)*
	N	Weighted %	Unadjusted RR (95%CI)	Adjusted RR (95%CI)	N	Weighted %	Unadjusted RR (95%CI)	Adjusted RR (95%CI)
Self-isolation ability/willingness
Yes, I would	1834	87.0			1847	87.6
No, I wouldn’t	168	8.0			131	6.2
Don’t know	106	5.0			130	6.2
Age (years)
18–34	466	90.8	Ref	Ref†	457	91.6	Ref	Ref‡
35–49	494	90.0	0.99 (0.95 to 1.1)	1.0 (0.96 to 1.1)	508	94.2	1.0 (0.99 to 1.1)	1.0 (0.98 to 1.1)
50–69	614	92.2	1.0 (0.98 to 1.1)	1.0 (0.97 to 1.1)	627	93.6	1.0 (0.99 to 1.1)	1.0 (0.96 to 1.1)
70 or older	262	94.9	1.1 (1.0 to 1.2)*	1.0 (0.96 to 1.1)	255	94.4	1.0 (0.99 to 1.1)	1.0 (0.96 to 1.1)
Sex
Male	878	90.7	Ref	Ref†	878	91.8	Ref	Ref‡
Female	957	92.5	1.0 (0.99 to 1.1)	1.0 (0.98 to 1.1)	969	94.9	1.1 (1.0 to 1.2)**	1.1 (1.0 to 1.2)*
Ethnicity
White group	1737	92.1	Ref	Ref†	1751	93.7	Ref	Ref‡
Black, Asian and minority ethnic	89	84.8	0.92 (0.84 to 0.99)*	0.89 (0.79 to 1.0)*	86	87.8	0.94 (0.87 to 1.0)	0.96 (0.87 to 1.1)
Marital status
Married, civil partnership or living as married	1128	92.3	Ref	–	1143	94.5	Ref	Ref‡
Separated, divorced or widowed	215	90.7	0.98 (0.94 to 1.2)		219	92.8	0.98 (0.95 to 1.1)	0.98 (0.93 to 1.1)
Never married	482	90.3	0.97 (0.95 to 1.1)		477	91.0	0.96 (0.93 to 0.99)*	0.99 (0.95 to 1.1)
Area of residence
London	241	91.6	Ref	–	243	92.7	Ref	–
North of England	427	91.2	0.99 (0.95 to 1.1)		430	93.7	1.0 (0.97 to 1.1)
Midlands and East of England	465	93.0	1.0 (0.97 to 1.2)		465	93.9	1.0 (0.97 to 1.1)
South of England	408	89.5	0.98 (0.93 to 1.1)		411	92.2	0.99 (0.95 to 1.0)
Northern Ireland, Scotland, Wales	294	92.7	1.0 (0.96 to 1.2)		297	94.3	1.0 (0.97 to 1.1)
Education
Degree or above	584	93.1	Ref	–	591	94.9	Ref	Ref§
Post-secondary	332	90.2	0.97 (0.93 to 1.1)		329	90.9	0.96 (0.92 to 0.99)*	0.95 (0.92 to 0.99)*
Secondary or below	863	91.3	0.98 (0.95 to 1.1)		873	93.6	0.98 (0.96 to 1.0)	1.0 (0.97 to 1.0)
Employment status
Working full time	799	91.4	Ref	Ref†	804	93.6	Ref
Working part time	255	90.4	0.99 (0.95 to 1.0)	0.98 (0.93 to 1.0)	263	92.9	0.99 (0.96 to 1.0)
Full-time student	105	93.8	1.0 (0.97 to 1.1)	1.0 (0.94 to 1.1)	97	89.0	0.95 (0.88 to 1.0)
Retired	450	95.1	1.1 (1.0 to 1.2)**	1.0 (0.96 to 1.1)	444	94.7	1.0 (0.98 to 1.1)
Unemployed or not working	185	89.8	0.98 (0.93 to 1.0)	1.0 (0.93 to 1.1)	191	94.1	1.0 (0.96 to 1.1)
Household income
£50000 and over	405	95.5	Ref	Ref¶	393	94.7	Ref
£30000–£49999	417	90.7	0.95 (0.92 to 0.98)**	0.95 (0.92 to 0.98)**	424	93.6	0.99 (0.95 to 1.2)
£20000–£29999	311	92.6	0.97 (0.94 to 1.1)	0.96 (0.93 to 1.0)	308	91.9	0.97 (0.93 to 1.1)
<£20000	363	88.3	0.93 (0.89 to 0.96)***	0.92 (0.88 to 0.96)***	383	93.0	0.98 (0.95 to 1.1)
Savings
£25000 or more	329	95.6	Ref	Ref¶	318	94.1	Ref	Ref**
£5000–£24999	319	95.2	1.0 (0.96 to 1.1)	1.0 (0.97 to 1.1)	317	95.8	1.0 (0.98 to 1.1)	1.0 (0.98 to 1.1)
£1000–£4999	274	92.3	0.96 (0.93 to 1.1)	0.99 (0.95 to 1.0)	272	92.8	0.98 (0.94 to 1.1)	0.99 (0.96 to 1.0)
£100–£999	217	90.0	0.94 (0.90 to 0.98)*	0.97 (0.92 to 1.1)	221	94.8	1.0 (0.97 to 1.1)	1.0 (0.96 to 1.1)
Less than £100	232	84.4	0.88 (0.83 to 0.93)***	0.90 (0.85 to 0.96)**	250	90.9	0.96 (0.92 to 1.0)	0.96 (0.91 to 1.1)
Housing tenure
Own outright	576	93.8	Ref	Ref¶	575	95.0	Ref	Ref††
Own with mortgage/shared ownership	571	92.1	0.98 (0.95 to 1.0)	1.0 (0.96 to 1.1)	584	95.0	1.0 (0.97 to 1.0)	1.0 (0.97 to 1.1)
Rented from private landlord	277	89.1	0.95 (0.91 to 0.99)*	0.97 (0.92 to 1.0)	297	94.3	0.99 (0.96 to 1.0)	1.0 (0.95 to 1.1)
Rented from local authority/housing association	188	87.9	0.94 (0.89 to 0.99)*	0.97 (0.91 to 1.0)	188	90.0	0.94 (0.90 to 0.99)*	0.94 (0.89 to 0.99)**
Live with parents, family or friends	197	92.9	0.99 (0.95 to 1.1)	1.0 (0.97 to 1.1)	178	88.1	0.92 (0.88 to 0.98)*	0.95 (0.89 to 1.0)

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*P<0.05, **p<0.01, ***p<0.001.

*Excluding those who responded ‘Don’t know’.

†Mutually adjusted for age, gender, ethnicity, employment status, household income, savings and housing tenure.

‡Mutually adjusted for age, gender, ethnicity, marital status, education, savings and housing tenure.

§Adjusted for age, gender, ethnicity, marital status and housing tenure.

¶Adjusted for age, gender, ethnicity and employment status.

**Adjusted for age, gender, ethnicity and marital status.

††Adjusted for age, gender, ethnicity, marital status and education.

RR, relative risk.

Some indicators of socioeconomic status were significantly associated with perceived ability and willingness to self-isolate. Respondents who held post-secondary but below degree-level education qualifications were less willing to self-isolate (90.9% vs 94.9% aRR: 0.95; 95%CI: 0.92 to 0.99) than respondents educated to degree level (table 3). Those with household incomes below £20000 were less likely to be able to self-isolate compared with those on household incomes of £50000 and above (88.3% vs 95.5%; aRR: 0.92; 95%CI: 0.88 to 0.96). Similarly, respondents with less than £100 in savings were less likely to be able to self-isolate compared with those with savings of £25000 or more (84.8% vs 95.6%; aRR: 0.90; 95%CI: 0.85 to 0.96). There was no effect on willingness to self-isolate by household income or amount of savings (table 3).

Those in accommodation rented from a private landlord, local authority or housing association were less likely to report being able to self-isolate, although this association was no longer significant when other sociodemographic factors were adjusted for. In terms of willingness to self-isolate, respondents renting accommodation from a local authority or housing association were less likely to be willing to self-isolate compared with those who owned their home outright (aRR: 0.94; 95%CI: 0.89 to 0.99) (table 3).

Discussion

This study reports on the perceptions and behaviour of the UK adult population in the 2days following the UK Government’s introduction of recommendations on social distancing on 16 March 2020.6 We found high levels of self-reported behavioural change. Notably, the most adopted measures, washing hands more frequently with soap and water, using hand sanitiser, and covering nose and mouth when sneezing or coughing, prominently featured in national public health campaigns from relatively early on in the epidemic,4 and mirror results seen in previous pandemics.29 However, there were marked differences between the perceived effectiveness and adoption of NPIs. This suggests that lack of knowledge on what measures are effective against COVID-19 is not a key driver of compliance in the UK population. In contrast, a similar study conducted in Hong Kong showed comparatively high-perceived effectiveness and adoption of preventive measures.24

Our results highlighted significant differences across demographic and socioeconomic strata for social distancing behaviour, ability to work from home, and the ability and willingness of people to self-isolate. There was a strong association between socioeconomic deprivation and ability to adopt NPIs. Although willingness to self-isolate was high overall, those from more disadvantaged backgrounds were less likely to be able to work from home or self-isolate if needed, suggesting the existence of structural barriers to adopting preventive behaviours in these groups. Specifically, our study found that those with less savings were the group least likely to adopt NPIs overall. As such, the barriers for this group appear the greatest. This is not surprising, as these individuals are likely to have less cushioning to withstand financial losses as a result of any NPIs that have a direct or indirect impact on employment or earnings.

The strength of this study is in the representative sample of the UK adult population, the ability to achieve our sample size quickly and the timeliness in relation to changing government recommendations. However, social distancing measures were only brought in 2days before the survey. Therefore, there may have not been enough time for people to fully implement these measures prior to their participation in the study. But many employers had already begun allowing staff to work from home in the week prior to the UK Government’s announcement, and ability and willingness to self-isolate do not measure behavioural change directly but intent. So, we believe our study does indeed measure attitudes and behaviours based on the most recent advice at the time of the survey. Social desirability bias is also possible given that participants were asked whether they were complying with government restrictions. However, this is less of an issue with online surveys where respondents are assured anonymity and answer questions in the privacy of their own home without any live human interaction. In addition, our sampling approach is prone to selection bias, for example by excluding participants without internet access and non-English speakers, and sampling from a panel of individuals who have specifically opted in to participate in online research activities. As in almost all population surveys, our study had unequal participation, with lower response among people from minority ethnic groups and older age groups. We reweighted the sample to account for such differential response, although this may not have overcome unknown participation biases. Furthermore, surveys collecting self-report data are generally subject to limitations including honesty, introspective ability and interpretation of the questions. The survey tool consisted of predominantly closed-ended questions. Thus, we were unable to explore responses in more depth.

Our findings highlight the stark choices faced by those in lower socioeconomic groups and suggest that unless the government intervenes to support these individuals, the impact of this epidemic will likely be felt unequally in our society. Not only this, but if a large proportion of the population continues to work while unwell, low compliance will render the various forms of social distancing less effective, as low-income workers are forced to choose between financial and physical health. Indeed, this behaviour has already been observed in the workplace in previous pandemics: workers without access to paid sick leave were more likely to work while unwell than those with paid sick leave.30 A study in China after the H7N9 epidemic found that only 7% of people reported willingness to self-quarantine.31 Also, during the Middle East respiratory syndrome outbreak in South Korea in 2015, there was heterogeneous uptake of preventive interventions.32

In the absence of a vaccine and treatments over the short term, high compliance with social distancing, self-isolation and household quarantine is paramount to reduce transmission and the impact of COVID-19. NPI compliance, risk perception and behaviour are not consistent across cultures, social status or time. Indeed, previous studies have shown that perceptions and behaviours often change over time.29 Therefore, current modelling projections of the impact of NPIs on morbidity and mortality are always provisional.7 Future COVID-19 models should explore the variation captured in this and previous studies to better estimate the impact of differential uptake of NPIs in the UK and beyond. It is also important to monitor behaviour throughout the epidemic to know when to implement further public health messaging, and when further or alternative government actions might be required, to mitigate falling compliance.

Supplementary Material

Acknowledgments

Footnotes

References