Adherence to mask wearing and social distancing and use of lateral flow tests during the COVID19 pandemic in England and Wales based on the Virus Watch community cohort study

Background Personal protective behaviours (PPBs) played a crucial role in limiting infection spread during the COVID-19 pandemic, yet adherence varied across communities. Understanding the factors influencing adherence is important, as PPBs will remain critical in future pandemics. Using behavioural science, we investigated the influences on adherence to PPBs, focusing on face mask wearing, social distancing, and lateral flow testing (LFT). Methods Two online surveys were conducted in July and August 2021 in England and Wales ( N = 20,488 (survey 1) and N = 26,613 (survey 2)). Survey questions were informed by the Capability, Opportunity, Motivation model of Behaviour (COM-B). Multivariate models examined associations between behavioural influences and adherence to PPBs. Results Most respondents reported wearing a face mask in public indoor places (88.5%) and maintaining a 1+ metre distance (86.8%) all or most of the time. After two doses of COVID-19 vaccine, adherence declined with 48.3% reporting meeting friends or family and 38.3% visiting indoor places more frequently. Motivation, Opportunity and Capability factors were significantly associated with increased odds of wearing a face mask and social distancing (p < 0.05). Among those using LFTs (68% of the sample), 50.4% engaged in routine testing, while 55.3% of non-users cited a perceived lack of necessity for testing. Routine testing was significantly associated with accurate interpretation of test results. Conclusions Despite reduced restrictions and high vaccination rates, overall adherence to PPBs remained high. Behavioural influences played a significant role in PPB use. These findings can inform tailored public health interventions and support future community-level emergency preparedness.