Why people did or did not follow COVID-19 prevention rules: a qualitative behaviour change study

What is it about?

This qualitative study examined why people did or did not follow eight COVID-19 prevention behaviours, including hand hygiene, face coverings, physical distancing, testing, and vaccination. Twenty-three participants working in schools, care homes, and warehouses across three local authorities took part in semi-structured interviews. Thematic analysis identified ten key themes covering knowledge, emotional responses, social influences, the physical environment, trust in leadership, and fatigue with restrictions. These themes were then mapped onto the COM-B model of behaviour change and the Theoretical Domains Framework, and a logic model was produced using the Behaviour Change Wheel to guide future intervention design. A distinctive methodological feature of the study is that all eight behaviours were analysed together within a single thematic analysis rather than examined separately. Why it's important Designing effective public health interventions for infectious disease requires a systematic understanding of what drives and blocks specific behaviours. This study applies established behaviour change theory, the COM-B model and Theoretical Domains Framework, to a cluster of COVID-19 prevention behaviours simultaneously, producing a ready-to-use logic model for intervention design. The multi-behaviour approach is a methodological advance with direct relevance beyond COVID-19, offering a replicable framework for future infectious disease outbreaks and antimicrobial stewardship campaigns. Conducted in high-risk occupational settings, the findings address a gap in knowledge about behaviour change in contexts where adherence is hardest to sustain.

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Why is it important?

Designing effective public health interventions for infectious disease requires a systematic understanding of what drives and blocks specific behaviours. This study applies established behaviour change theory, the COM-B model and Theoretical Domains Framework, to a cluster of COVID-19 prevention behaviours simultaneously, producing a ready-to-use logic model for intervention design. The multi-behaviour approach is a methodological advance with direct relevance beyond COVID-19, offering a replicable framework for future infectious disease outbreaks and antimicrobial stewardship campaigns. Conducted in high-risk occupational settings, the findings address a gap in knowledge about behaviour change in contexts where adherence is hardest to sustain.