Intention of UK residents to wear facemasks and practise social distancing during the next respiratory virus pandemic
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
Wearing facemasks and practising social distancing slow the spread of respiratory pathogens. However, in the event of a new pandemic emerging, the willingness of populations to voluntarily adopt these behaviours is unclear.
Methods
A discrete choice experiment was conducted among 2,006 UK-based adults. Participants were presented with hypothetical scenarios describing the emergence of a respiratory virus pandemic and were asked to choose when they would wear facemasks and practise social distancing. A mixed multinomial logit model was used to jointly estimate how disease severity and prevalence, uncertainty in these quantities, and individual-level characteristics influence behavioural choices.
Findings
Participants were averse to facemasks and social distancing in the absence of pandemic risk. For each ten-unit increase in severity (10 additional hospitalisations/1,000 infections), the odds of always wearing a facemask outside the home increased by 15.9% (95%CI: 14.3%, 17.5%), relative to rarely/never, and the odds of avoiding all people as much as possible increased by 16.4% (14.6%, 18.2%), relative to not avoiding anyone. Greater disease prevalence, uncertainty in disease severity or disease prevalence, a university education, prior COVID-19 vaccination and non-white ethnicity were also associated with choosing to always wear facemasks and avoid all people as much as possible. The probability of participants choosing to rarely/never wear facemasks varied from 13.4% (11.9%, 14.9%) in the lowest-risk scenario to 1.4% (1.2%, 1.7%) in the highest-risk scenario.
Interpretation
Perceived risks of disease and associated uncertainty drive intention of UK adults to adapt their behaviour in a future pandemic.
Funding
Medical Research Foundation.
Research in Context
Evidence before this study
In the aftermath of the COVID-19 pandemic, evidence on intended behaviour change during a future pandemic is scarce in the UK and globally. We searched PubMed with no language restrictions from 01/01/2020 to 18/05/2026 using the terms (“behavior” OR “behaviour” OR “mask” OR “distancing” OR “voluntary” OR “intention“) AND (“future pandemic” OR “next pandemic” OR “hypothetical pandemic” OR “Disease-X” OR “Pathogen-X”). An overview of UK biosecurity priorities highlights behaviour change as a critical yet understudied component of pandemic preparedness. A systematic review identified strong preferences for voluntary compliance with facemasks and social distancing, rather than mandatory enforcement. Choice experiments assessed the intention of different populations to get vaccinated or travel during the next pandemic, but no studies evaluated intention to wear facemasks and practise social distancing, nor associations between behaviour change and epidemic characteristics.
Added value of this study
This choice experiment among 2,006 UK-based adults is the first of its kind to assess population preferences for wearing facemasks and practising social distancing during the next respiratory virus pandemic. Although participants were averse to both behaviours in the absence of risk, they were increasingly likely to prefer them given higher estimates of disease prevalence or severity. Participants preferred to exercise greater caution when faced with greater epidemic uncertainty, and to exercise caution to a similar degree across both behaviours, instead of favouring one over the other. Associations with individual-level characteristics, including education, ethnicity and prior COVID-19 vaccination, highlight groups with less intention to modify their behaviour and potentially at greater risk of infection and transmission. These estimated relationships between behaviour change and epidemic characteristics may be harnessed in transmission dynamic modelling, outbreak forecasting and risk assessment.
Implications of all the available evidence
In the event of a future pandemic, adults in the UK intend to protect themselves and others to a greater degree when faced with increasing or more uncertain epidemic risk. Clear and concise communication of risk and its associated uncertainty may better enable populations to adapt their behaviour as appropriate to the evolving epidemiological context. Reducing uncertainty via investment in epidemiological surveillance could inadvertently reduce voluntary risk mitigation by excluding probabilities of very high risk.
