“We want to live a little longer and our family want[s] us around”: A summative content analysis of adherence to COVID‐19‐related guidelines using the Theoretical Domains Framework

Abstract

Objective Public adherence to COVID‐19‐related government guidance varied during the initial lockdown in the UK, but the determinants of public adherence to such guidance are unclear. We capture spontaneous reflections on adherence to UK government guidance from a representative UK sample, and use the TDF to identify key determinants of COVID‐related behaviours. Design The design was cross‐sectional. Methods Qualitative data were collected from a large sample of UK adults ( N = 2,252) via an online questionnaire as part of a wider survey about the UK public’s responses to the government’s COVID‐19‐related guidance. Summative content analysis was used to identify key guideline terms in the data, followed by latent analysis to interpret the underlying meanings behind the terms using the TDF as an analytical framework. Results Six TDF domains were identified in the data: Environmental Context and Resources; Beliefs about Consequences; Social Influences; Memory, Attention and Decision Processes; Emotion; and Knowledge. Although the samples were motivated and capable of adhering, limitations in their environments, resources, and social support mechanisms restricted behaviour. Self‐reported adherence was sensitive to positive and negative beliefs about the effectiveness of the measures, in addition to interpretations of the terms ‘essential’ and ‘necessary’ in the guidance. Conclusions Despite extensive structural obstacles to adherence, the majority of the British public were able to follow government COVID‐19‐related instructions, provided they had sufficient resources, social support, and positive perceptions about the effectiveness of the measures. Ambiguities surrounding key terminology in the guidance left room for interpretation, which may have contributed to non‐adherence.

Effectiveness of communications in enhancing adherence to public health behavioural interventions: a COVID-19 evidence review

“…Overall adherence was generally high. Eight studies [27][28][29]33,[36][37][38][39] reported high adherence among participants, with a further two studies [30,31] reporting moderately high adherence. Three studies didn't provide data on levels of adherence per se, only factors related to adherence.…”

“…sound evidence for a non-randomized study but not comparable to an RCT [24]). Among the qualitative studies, all seven studies [32][33][34][35][36][37][38] were deemed high-quality qualitative studies according to CASP criteria.…”

“…This review highlights the importance of qualitative study findings in supporting research and policy understandings of the use and effectiveness of communication for NPI uptake and adherence. For example, it provided evidence that, from the perspectives of those receiving and interpreting guidance, the way it was communicated may have been insufficiently clear, overly complex or frequent, was perceived as inconsistent or conflicting [32,33,[37][38][39]. However, the incorporation of advice arising from qualitative research evidence can sometimes meet policy resistance especially when viewed in relation to questions of 'research bias' and attention to the 'hierarchy of evidence' commonly attributed to randomized and controlled quantitative studies.…”

“…Five of these studies were qualitative, and so clarity of communication (or lack thereof), was defined by participants themselves (i.e. they perceptions of the how clear information was linked to adherence) [32,33,[37][38][39]. One observational study measured quantitatively people's ratings of clearness of information and 'consistency of instructions and recommendations' finding that these were significantly positively related to protective behaviours [29].…”

Environmental determinants of infectious and chronic disease prevention behaviours: A systematic review and thematic synthesis of qualitative research

“…"I try to stay 2 m away from everyone however this is not always possible in a small shop and most customers do not care about social distancing." (Leather et al, 2022) Comfort as a driver for behaviour (n = 45). Comfort, enjoyment, and convenience were drivers for behaviour change within the smoke-free and COVID-19 literature.…”