Investigating the consequences of misunderstanding public-health warnings against COVID-19

Wearing masks, social-distancing, staying home: Those preventive measures were least likely to be followed by Canadians who were least informed about how best to stop the spread of COVID-19 during the pandemic.

That's the conclusion of a new study by sociology and psychology researchers at Université de Montréal, based on survey results of close to 2,700 Canadians between April 2020 and April 2021. The study is published this month in the journal Scientific Reports.

Previous studies have suggested that individuals who are young, male, with low revenue, less educated, living out West or politically conservative are more likely to have ignored government health warnings against COVID-19, the UdeM study notes.

"Going into our study, we suspected that people who didn't understand the directives the government was issuing were less likely to follow them," said first author Clémentine Courdi, an UdeM doctoral student and research assistant to sociology professor Éric Lacourse.

"We also expected that people who relied mostly on informal sources to get their information on COVID-19 were less likely to follow what the public-health authorities were recommending," she said.

"And that's what we found was true: those who knew the most and who understood the best adhered to the rules much more than those who didn't understand the recommendations. Thankfully, the former were the great majority; those who didn't take any precautions at all were really in the minority."

The study is part of a project called "COVID-19 Canada: The End of the World as We Know It?", conducted by UdeM psychology professor Roxane de la Sablonnière, director of the Social Change and Identity Laboratory. The longitudinal survey was conducted by the Toronto polling firm Delvinia using AskingCanadians, a database of more than 1 million people. In all, 2,629 respondents took part in the multiple survey segments used for this study.

Paid for their involvement, the participants answered at least four times over the year the survey was conducted, with questions regarding their adherence to public health measures, their level of understanding of those measures, and where they got their information about COVID-19.

They were asked on a scale from 1 to 10 (never to always) how often they respected the two-meters social-distancing rule when not at home, whether they stayed at home as much as they could, and whether they wore a mask in public.

They were also asked to self-assess, again on a scale of of 1 to 10, how well they understood their government's public health measures, both federal and provincial, to combat the spread of COVID-19 and adhere to the recommended guidelines.

"Our results show that the level of perceived understanding was positively linked to adherence to sanitary measures, such that the higher the self-assessed level of understanding was, the higher were the chances of a person following a high adherence trajectory, and vice-versa," the study's authors note.

"Although a high level of understanding does not guarantee a perfect adherence, a lack of comprehension regarding COVID-19 and associated preventive measures hinders adherence," they concluded.

"Health literacy ... the capacity to understand, access, and use health-related information, is the primary predictor of understanding an illness and the impact of related preventive measures or treatment, regardless of other factors such as education," the authors added.

"Our results simply suggest that this relation holds true in the case of COVID-19, meaning that better health literacy would improve individuals' level of understanding and thus have a positive influence on adherence to preventive measures."

In sum, Courdi and her co-authors recommended, "governments and public-health agencies should strive to provide clear and coherent communication regarding public-health measures if they want to ensure a higher level of understanding and improve adherence."

The study's participants were also asked which sources of information they trusted the most regarding COVID-19, ranging from family and friends to work colleagues, the media and the World Health Organization, as well as a wide range of social media.

In the end, however, it wasn't so much the sources that mattered, but whether the correct information had sunk in.

"Overall," the authors noted, "we showed that perceived understanding of information was a key predictor of adherence to all COVID-19 health measures, regardless of the type of sources used by participants. "