Determinants of adherence to COVID-19 preventive behaviours in Canada: Results from the iCARE Study

Objective Key to slowing the spread of SARS-Cov-2 is adherence to preventive behaviours promoted through government policies, which may be influenced by policy awareness, attitudes and concerns about the virus and its impacts. This study assessed determinants of adherence to major coronavirus preventive behaviours, including demographics, attitudes and concerns, among Canadians during the first pandemic wave. Methods As part of the iCARE study ([www.iCAREstudy.com][1]), we weighted data from two population-based, online surveys (April and June, 2020) of Canadian adults. Questions tapped into behaviour change constructs. Multivariate regression models identified determinants of adherence. Results Data from 6,008 respondents (51% female) were weighted for age, sex, and province. Awareness of government policies was high at both time points (80-99%), and adherence to prevention behaviours was high in April (87.5%-93.5%) but decreased over time, particularly for avoiding social gatherings (68.1%). Adherence was worse among men, those aged 25 and under, and those currently working. Aligned with the Health Beliefs Model, perceptions of the importance of prevention behaviours and the nature of people’s COVID-19-related concerns were highly predictive of adherence. Interestingly, health and social/economic concerns predicted better adherence, but having greater personal financial concerns predicted worse adherence at both time points. Conclusion Adherence to COVID-19 prevention behaviours was worse among men, younger adults, and workers, and deteriorated over time. Perceived importance of prevention behaviours measures and health and social/economic concerns predicted better adherence, but personal financial concerns predicted worse adherence. Results have implications for tailoring policy and communication strategies during subsequent pandemic waves. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement iCARE is supported by the Canadian Institutes of Health Research (CIHR: MM1 174903; MS3 173099; SMC-151518) the Canada Research Chairs Program (950 232522, Chair holder: Dr. Kim L. Lavoie), the Fonds de recherche du Quebec - sante (FRQS: 251618 and 34757) the Fonds de recherche du Quebec Societe et culture (FRQSC: 2019-SE1-252541) and the Ministere de l Economie et de l Innovation du Quebec (2020 2022 COVID19 PSOv2a 51754). Study sponsors had no role in the design of the database and data collection. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The primary REB approval was obtained from the Comite d ethique de recherche du Centre integre universitaire de sante et de services sociaux du Nord-de-l ile-de-Montreal (CIUSSS-NIM) approval # : 2020-2099 / 25-03-2020. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data from the iCARE Study is open-access at the following link: [1]: http://www.iCAREstudy.com