Even as government mandates eased, a new study shows that Australians, especially those with preexisting conditions, are steadfast in their support for COVID-19 precautions, revealing a cautious and health-conscious public.

Study. Attitudes and Behaviours Regarding COVID-19 Mitigation Strategies in Australians With an Underlying Health Condition: A Cross-Sectional Study. Image Credit: Ground Picture / Shutterstock

In a recent study published in the journal Health Expectations, researchers used a large nationwide cross-sectional study design to investigate the impacts of participants’ preexisting medical conditions on their behaviors and perceptions towards nationally implemented anti-COVID-19 mitigation measures. The survey-based study included 2,867 participants and revealed that almost three-quarters of participants (74%) believed current mitigation measures were too lenient and expressed a desire to return to public mask mandates. Similarly, large proportions would prefer five days per week isolation measures (66%).

Notably, for those with psychiatric conditions, most individuals with preexisting health concerns were more cautious and stricter in complying with COVID-19 mitigation measures than their healthy counterparts.

Background

The coronavirus disease of 2019 (COVID-19) remains one of the worst disease outbreaks in human history, infecting more than 770 million individuals and claiming more than 7 million lives since its discovery in late 2019. While the development and government-promoted dissemination of vaccines was instrumental in curbing the transmission of the disease-causing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, government-mandated social distancing behaviors and similar mitigation public health strategies were crucial in slowing disease spread during the early stages of the pandemic.

Recent research has underscored the associations between preexisting health conditions and COVID-19 infections. People with preexisting health conditions such as cardiovascular diseases (CVDs), respiratory diseases, diabetes, and immunocompromised individuals are at higher risk of contracting COVID-19 with more adverse outcomes than their healthy counterparts (Australian Chief Medical Officer, World Health Organisation [WHO]). Unfortunately, studies investigating whether the heightened risk may translate to altered attitudes and behaviors regarding reversing policy mandates against COVID-19 remain lacking in the literature.

“With the achievement of high vaccination rates, public health measures to prevent COVID-19 infections have eased in Australia. Masks are no longer mandated, even in healthcare settings, and mandatory isolation periods for COVID-19 ceased in October 2022… In contrast, in the United States, 5 days of isolation remained until March 2024, and 1 day of isolation still continues to be recommended.”

About the study

The present study aims to fill this gap in the literature by describing the attitudes and behaviors of Australians toward anti-COVID-19 mitigation strategies such as mask-wearing, handwashing/sanitizer, avoidance of crowds, and vaccination. The National Health and Medical Research Council (NHMRC) Centre for Research Excellence (CRE) conducted the present cross-sectional study on Airborne Threats to Health (BREATHE) between 9^th to 25^th January 2023.

Participants for the study were invited through Dynata using randomly distributed survey links across all Australian states and territories. Participants above the age of 18 were included in the study, while those who did not complete questionnaires and those with multiple answers failing quality checking were excluded. The questionnaire comprised 38 questions across 13 main topics – demographics (13 questions), social distancing (14 questions), eligibility screening (3 questions), mask-wearing (4 questions), sanitizer and handwashing (3 questions), and vaccinations (1 question).

The primary outcome of interest in this study was the attitudes and behaviors of participants toward anti-COVID-19 mitigation measures. The exposures include participants’ self-reported underlying health concerns prior to contracting a COVID-19 infection. Exposures were classified into six categories for statistical analysis – 1. Cardiometabolic, 2. Respiratory, 3. Immune-related, 4. Allergies, 5. Neurological, and 6. Mental health.

Statistical analysis included the descriptive summary of participants’ outcomes and the use of logistic regression models to elucidate the associations between exposures and outcomes.

Study findings

Of the 2,909 participants initially selected for the study, 42 failed to meet the study inclusion criteria, leaving a sampling cohort of 2,867 participants (mean age = 47; 54% women). The study cohort was predominantly English-speaking (85%), with Australian-born (75%) participants, while Aboriginal and Torres Strait Islander individuals comprised the minority (4%).

Study findings highlighted that individuals with comorbidities represented the statistical majority (54%), not the minority as previously assumed. Cardiometabolic and allergies were observed to be the most frequently reported comorbidities (28% and 23%, respectively). An association between age and comorbidity frequency was noted, with older individuals more likely to report preexisting health concerns. Similar trends were observed among employed versus unemployed participants, with the former group reporting healthier outcomes than the latter.

Notably, most participants called for the continuation of anti-COVID-19 mitigation measures even following the apparent decline in SARS-CoV-2 transmission rates. More than 84% of participants reported being vaccinated, 80% regularly washed their hands, and 77% reported avoiding close contact with symptomatic people.

“A majority of participants reported that they felt wearing an N95/P2 face mask reduced their risk of COVID more than a cloth or surgical mask (n = 2143; 75%), and that they would stay home if they exhibited symptoms of COVID (n = 2121; 74%). Most participants disagreed with the statement that there was no need to wear a mask because the pandemic is over (n = 2108; 74%) and would have preferred the 5-day isolation mandate to remain (n = 1903; 66%).”

The data also indicated that age and preexisting health conditions tended to slightly skew these results, with individuals older than 45 years and those with comorbidities expressing heightened caution compared to their healthier counterparts.

Conclusions

The present study highlights the outlooks and behaviors of Australians in complying with anti-COVID-19 mitigation measures such as wearing face masks, vaccinations, and social distancing. Surprisingly, more than 50% of the cohort under study reported preexisting health concerns prior to the onset of the COVID-19 pandemic, which contrasts with previous reports of comorbid individuals representing the population minority.

Notably, older and comorbid participants were observed to align their behaviors with COVID-19 mitigation measures significantly more frequently than their healthier counterparts. The findings suggest that most Australians, irrespective of their present health, support the continuation of COVID-19 mitigation measures and continue to follow social distancing and face-mask regulations despite the cessation of government mandates.