Behavioral Beliefs Predict Recommended Behaviors, Especially When Trust in Public Health Sources is Low: Evidence from a Longitudinal Study of Three COVID-19 Prevention Behaviors Among U.S. Adults

Abstract

Public distrust in official sources of health information and uncertainty about novel guidelines may discourage engagement in recommended disease prevention practices. The current study tests the hypothesis that building confidence in positive behavioral outcomes may support recommendation following even in the context of low trust in recommendation sources. This set of longitudinal studies examines the main and interaction effects of trust in official sources and behavioral beliefs in their prediction of recommended COVID-19 prevention behaviors (facemask wearing, social distancing, vaccination). Repeated measurement data were collected from a nationally representative sample of U.S. adults in May/June 2020 (T1; n = 1074), July 2020 (T2; n = 889), and April/June 2021 (T3; n = 750). All five tests, using lagged linear regression, found negative interactions between trust and behavioral beliefs, as hypothesized; three were significant (T1-T2: facemask wearing B=-0.10, SE = 0.04; T1-T3: social distancing B=-0.20, SE = 0.06; T2-T3 vaccination B=-0.27, SE = 0.10) and two were consistent albeit not significant (T1-T3: social distancing B=-0.13, SE = 0.08; T1-T3: facemask wearing B=-0.11, SE = 0.06). Supporting hypotheses, trust in recommendation sources predicted behavior most among those who were less certain about behavioral outcomes and confidence in behavioral benefits predicted behavior most among those with low trust in recommendation sources. Theoretical and practical implications are discussed.

Acknowledgments

Thank you to Robert Hornik, Emma Jesch, and Danielle Clark for their feedback and support on this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

¹ https://aspredicted.org/YMF_YL6:

² Two factors influenced the decision to combine vaccinated respondents with those who were “very likely” to get vaccinated. First, the T3 sample was collected at two time points (April and June 2021). Respondents who were randomly selected for the June survey had two additional months to become vaccinated than those selected for the April survey. Therefore, vaccination status and intention had different meanings depending on timing of T3 participation. While 54% of respondents in the April sample had been vaccinated, 64% had been vaccinated in the June sample. Second, intention at T2 was strongly associated with behavior at T3, consistent with the IMBP (Fishbein & Ajzen, 2011). Of those who responded, they were “very likely” to get a hypothetical COVID-19 vaccine at T2, 82% had received at least one dose at T3; In comparison, only 23% of those who were “very unlikely” at T2 had received a dose at T3. Given nearly all high intenders were vaccinated by T3, it was assumed most unvaccinated high intenders at T3 would soon be vaccinated. This justified the creation of a T3 intention/behavior score that placed intention and behavior on the same continuum.

³ Analyses did not include measurement of the effects of T2 independent variables on T3 facemask and social distance behavior because beliefs relevant to these behaviors were not measured at T2. Similarly, analyses did not include measurement of the effects of T1 vaccination beliefs on T2 or T3 vaccination outcomes because vaccination beliefs were not measured at T1.

Additional information

Funding

This work was supported by the Annenberg School for Communication at the University of Pennsylvania.