Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America.
Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America.
PLoS One. 2022 May 3;17(5):e0267261. doi: 10.1371/journal.pone.0267261. eCollection 2022.
Even early in the COVID-19 pandemic, adherence to physical distancing measures was variable, exposing some communities to elevated risk. While cognitive factors from the Health Belief Model (HBM) and resilience correlate with compliance with physical distancing, external conditions may preclude full compliance with physical distancing guidelines. Our objective was to identify HBM and resilience constructs that could be used to improve adherence to physical distancing even when full compliance is not possible. We examined adherence as expressed through 7-day non-work, non-household contact rates in two cohorts: 1) adults in households with children from Minnesota and Iowa; and 2) adults ≥50 years-old from Minnesota, one-third of whom had Parkinson's disease. We identified multiple cognitive factors associated with physical distancing adherence, specifically perceived severity, benefits, self-efficacy, and barriers. However, the magnitude, and occasionally the direction, of these associations was population-dependent. In Cohort 1, perceived self-efficacy for remaining 6-feet from others was associated with a 29% lower contact rate (RR 0.71; 95% CI 0.65, 0.77). This finding was consistent across all race/ethnicity and income groups we examined. The barriers to adherence of having a child in childcare and having financial concerns had the largest effects among individuals from marginalized racial and ethnic groups and high-income households. In Cohort 2, self-efficacy to quarantine/isolate was associated with a 23% decrease in contacts (RR 0.77; 95% CI 0.66, 0.89), but upon stratification by education level, the association was only present for those with at least a Bachelor's degree. Education also modified the effect of the barrier to adherence leaving home for work, increasing contacts among those with a Bachelor's degree and reducing contacts among those without. Our findings suggest that public health messaging tailored to the identified cognitive factors has the potential to improve physical distancing adherence, but population-specific needs must be considered to maximize effectiveness.
即使在 COVID-19 大流行早期，遵守身体距离措施的情况也各不相同，使一些社区面临更高的风险。虽然健康信念模型（HBM）和韧性的认知因素与遵守身体距离相关，但外部条件可能会妨碍完全遵守身体距离指南。我们的目标是确定可以用来提高对身体距离的遵守率的 HBM 和韧性结构，即使完全遵守是不可能的。我们通过明尼苏达州和爱荷华州有孩子的家庭中的成年人以及明尼苏达州≥50 岁的成年人（其中三分之一患有帕金森病）的两个队列，检查了通过 7 天非工作、非家庭接触率来表达的遵守情况。我们确定了与身体距离遵守相关的多种认知因素，特别是感知严重程度、益处、自我效能和障碍。然而，这些关联的大小，有时甚至方向，都取决于人群。在队列 1 中，与他人保持 6 英尺距离的感知自我效能与接触率降低 29%相关（RR 0.71；95%CI 0.65，0.77）。这一发现与我们研究的所有种族/族裔和收入群体都一致。在儿童保育中有孩子和有经济问题的人在遵守过程中的障碍，对来自边缘化种族和族裔群体和高收入家庭的个体的影响最大。在队列 2 中，自我隔离的自我效能与接触减少 23%相关（RR 0.77；95%CI 0.66，0.89），但在按教育程度分层时，这种关联仅存在于至少有学士学位的人群中。教育也改变了遵守离开家工作的障碍的效果，增加了学士学位人群的接触，减少了没有学士学位的人群的接触。我们的研究结果表明，针对确定的认知因素量身定制的公共卫生信息有可能提高对身体距离的遵守率，但为了最大限度地提高效果，必须考虑特定人群的需求。
