Sociodemographic and Health Belief Model Factors Associated with Nonadherence to COVID-19 Mitigation Strategies in the United States

Ann Behav Med. 2021 Jun 28;55(7):677-685. doi: 10.1093/abm/kaab038.


Background and purpose: Virus mitigation strategies such as adhering to stay-at-home orders, practicing social distancing, and engaging in personal protective behaviors are central to slowing the spread of COVID-19. This population-based cohort study sought to identify sociodemographic characteristics and Health Belief Model factors that are associated with nonadherence to COVID-19 mitigation strategies with the goal of informing public health messaging campaigns.

Methods: An online population-based survey was distributed via social media over an 8-week period from April 13, 2020, to June 8, 2020.

Results: Data were derived from 2,222 adults (57% female; 40% racial/ethnic minorities). Univariate analyses revealed that men, younger aged (18-30 years) and unmarried adults, and noncollege educated individuals had lower levels of perceived threat, control, and knowledge about COVID-19 (p ≤ .001). Multivariable linear regression models further revealed that male gender was significantly associated with reporting lower levels of adherence to COVID-19 mitigation strategies (p < .001), and that higher levels of perceived threat, perceived control, and knowledge about how to keep oneself and others safe from COVID-19 were significantly associated with reporting higher levels of adherence to COVID-19 mitigation strategies (p < .01).

Conclusions: Findings suggest that public health appeals that target men, emphasize individual risk, and provide clear, consistent guidance on what individuals can do to decrease their risk for COVID-19 may be effective in motivating increased mitigation adherence.

Keywords: COVID-19; Health belief model; Mitigation behaviors; Social distancing; Stay at home orders.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • COVID-19 / prevention & control*
  • Communicable Disease Control*
  • Educational Status
  • Female
  • Guideline Adherence*
  • Health Belief Model*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Linear Models
  • Male
  • Marital Status
  • Middle Aged
  • SARS-CoV-2
  • Sex Factors
  • Surveys and Questionnaires
  • United States
  • Young Adult