Infection Control Behavior at Home During the COVID-19 Pandemic: Observational Study of a Web-Based Behavioral Intervention (Germ Defence)
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Abstract
To control the COVID-19 pandemic, people should adopt protective behaviors at home (self-isolation, social distancing, putting shopping and packages aside, wearing face coverings, cleaning and disinfecting, and handwashing). There is currently limited support to help individuals conduct these behaviors.
Objective
This study aims to report current household infection control behaviors in the United Kingdom and examine how they might be improved.
Methods
This was a pragmatic cross-sectional observational study of anonymous participant data from Germ Defence between May 6-24, 2020. Germ Defence is an open-access fully automated website providing behavioral advice for infection control within households. A total of 28,285 users sought advice from four website pathways based on household status (advice to protect themselves generally, to protect others if the user was showing symptoms, to protect themselves if household members were showing symptoms, and to protect a household member who is at high risk). Users reported current infection control behaviors within the home and intentions to change these behaviors.
Results
Current behaviors varied across all infection control measures but were between sometimes (face covering: mean 1.61, SD 1.19; social distancing: mean 2.40, SD 1.22; isolating: mean 2.78, SD 1.29; putting packages and shopping aside: mean 2.75, SD 1.55) and quite often (cleaning and disinfecting: mean 3.17, SD 1.18), except for handwashing (very often: mean 4.00, SD 1.03). Behaviors were similar regardless of the website pathway used. After using Germ Defence, users recorded intentions to improve infection control behavior across all website pathways and for all behaviors (overall average infection control score mean difference 0.30, 95% CI 0.29-0.31).
Conclusions
Self-reported infection control behaviors other than handwashing are lower than is optimal for infection prevention, although handwashing is much higher. Advice using behavior change techniques in Germ Defence led to intentions to improve these behaviors. Promoting Germ Defence within national and local public health and primary care guidance could reduce COVID-19 transmission.
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SciScore for 10.1101/2020.06.22.20137406: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Website usage and engagement data was collected using Google Analytics embedded in the site. Googlesuggested: (Google, RRID:SCR_017097)Results from OddPub: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations of the study: As a cross-sectional observation of an active intervention, Germ Defence lacks longitudinal follow-up. Care must be taken when interpreting findings within the …
SciScore for 10.1101/2020.06.22.20137406: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Website usage and engagement data was collected using Google Analytics embedded in the site. Googlesuggested: (Google, RRID:SCR_017097)Results from OddPub: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations of the study: As a cross-sectional observation of an active intervention, Germ Defence lacks longitudinal follow-up. Care must be taken when interpreting findings within the rapidly changing context of the COVID-19 pandemic. Although our data suggests that the frequency of infection control behaviours did not change during the study (see Appendix 1), we do not have comparable data from before the pandemic. Our method of categorisation using website pathways may not be accurate for some users, or might overlook individual differences (for example, some users in the ‘Protect myself’ category may be extremely high risk). Our data may not be a representative sample from the wider UK population, for several reasons. Firstly, users of Germ Defence are likely to be more motivated and report higher frequencies of infection control behaviours. Secondly, although analytic data indicates that the large majority of users of the intervention were from the UK, we could not identify non-UK users within behavioural data. Finally, self-reported infection control behaviours may not be accurate reflections of actual behaviours occurring within households. However, none of these limitations affect our main findings; indeed, people are prone to over-report protective behaviours, further highlighting the need for improvement.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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