Adherence to mask wearing and social distancing following vaccination and use of lateral flow testing during the COVID-19 pandemic in England and Wales: Results from a cross-sectional study nested within the prospective Virus Watch household community cohort study

Abstract

Abstract Background Personal protective behaviours (PPBs) played a crucial role in limiting the spread of infection during the COVID-19 pandemic, yet adherence to these behaviours varied at population level. Understanding the factors influencing adherence to protective behaviours is important, as PPBs will be a critical part of the response 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, the first gathering data on mask wearing and social distancing, and the second on lateral flow testing, were conducted in July and August 2021 with a sample from England and Wales (N = 20,488 (survey 1) and N = 26,613 (survey 2)). The survey questions were designed based on the Capability, Opportunity, Motivation (COM-B) model of Behavior. Multivariate models were used to examine associations between identified influences and adoption of these protective behaviours. 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, social distancing decreased 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 covering and social distancing. Among individuals who indicated using an LFT (comprising 68% of the total sample), 50.4% reported engaging in routine testing. For those who had never used an LFT, the predominant reason cited was a perceived lack of necessity for testing (55.3%). Statistically significant associations were found between routine testing and accurate interpretation of test results across all LFT belief-based statements (p < 0.05). Conclusions Findings indicated high levels of adherence to face masks, social distancing, and lateral flow testing, even amid reduced restrictions and high vaccination rates. Utilising a behavioural science framework, factors related to capability, opportunity, and motivation were found to significantly influence the use of these protective behaviours. Our recommendations can inform public health intervention design and guide the selection of implementation strategies for public health emergencies preparedness.