BACKGROUND: A central component of the public health strategy to control the COVID-19 pandemic involves encouraging mask wearing and social distancing to protect individuals from acquiring and transmitting the virus .
OBJECTIVE: This study aims to understand the psychological factors that drive adoption or rejection of these protective behaviors, which can inform public health interventions to control the pandemic .
METHODS: We conducted an online survey of a representative sample of 1074 US adults and assessed three novel potential predictors of COVID-19 behaviors: trait reactance, COVID-19 conspiracy beliefs, and COVID-19 apocalypse beliefs . Key outcomes (dependent variables) included an index of COVID-19 protective behaviors, the number of trips taken from the home, and COVID-19 knowledge .
RESULTS: In bivariate analyses, all three predictors were significantly correlated in the hypothesized direction with the three COVID-19 outcomes . Specifically, each predictor was negatively (P <.01) correlated with the COVID-19 protective behaviors index and COVID-19 knowledge score, and positively correlated with trips taken from home per week (more of which was considered higher risk). COVID-19 protective behaviors and COVID-19 knowledge were significantly lower in the top median compared to the bottom median for all three predictors . In general, these findings remained significant after adjusting for all novel predictors plus age, gender, income, education, race, political party, and religiosity . Self-identified Republicans (vs other political affiliations) reported the highest values for each of the novel predictors .
CONCLUSIONS: This study can inform the development of health communication interventions to encourage the adoption of COVID-19 protective behaviors . Interestingly, we found that higher scores of all three novel predictors were associated with lower COVID-19 knowledge, suggesting that lack of an accurate understanding of the virus may be driving some of these attitudes; although, it is also possible that these attributes may interfere with one's willingness or ability to seek and absorb accurate health information . These individuals may be particularly immune to accepting new information and yielding their beliefs . Health communication professionals may apply lessons learned from countering similar beliefs around climate change and vaccine hesitancy . Messages designed for individuals prone to reactance may be more effective if they minimize controlling language and emphasize the individual's independence in adopting these behavioral recommendations . Messaging for those who possess conspiracy beliefs should similarly not assume that providing evidence contrary to these beliefs will alone alter behavior . Other communication techniques such as rolling with resistance, a strategy used in motivational interviewing, may be helpful . Messaging for those with apocalyptic beliefs may require using religious leaders as the message source and using scripture that would support the adoption of COVID-19 protection behaviors.