Observations and conversations: how communities learn about infection risk can impact the success of non-pharmaceutical interventions against epidemics

Background Individual behavioural decisions are responses to a person’s perceived social norms that could be shaped by both their physical and social environment. In the context of the COVID-19 pandemic, these environments correspond to epidemiological risk from contacts and the social construction of risk by communication within networks of friends. Understanding the circumstances under which the influence of these different social networks can promote the acceptance of non-pharmaceutical interventions and consequently the adoption of protective behaviours is critical for guiding useful, practical public health messaging. Methods We explore how information from both physical contact and social communication layers of a multiplex network can contribute to flattening the epidemic curve in a community. Connections in the physical contact layer represent opportunities for transmission, while connections in the communication layer represent social interactions through which individuals may gain information, e.g. messaging friends. Results We show that maintaining focus on awareness of risk among each individual’s physical contacts promotes the greatest reduction in disease spread, but only when an individual is aware of the symptoms of a non-trivial proportion of their physical contacts (~ ≥ 20%). Information from the social communication layer without was less useful when these connections matched less well with physical contacts and contributed little in combination with accurate information from physical contacts. Conclusions We conclude that maintaining social focus on local outbreak status will allow individuals to structure their perceived social norms appropriately and respond more rapidly when risk increases. Finding ways to relay accurate local information from trusted community leaders could improve mitigation even where more intrusive/costly strategies, such as contact-tracing, are not possible.

Perceived Social Norms Guide Health Care Decisions for Oneself and Others: A Cross-Sectional Experiment in a US Online Panel

Background: Global aging has increased the reliance on surrogates to make health care decisions for others. We investigated the differences between making health care decisions and predicting health care decisions, self-other differences for made and predicted health care decisions, and the roles of perceived social norms, emotional closeness, empathy, age, and gender. Methods: Participants ( N = 2037) from a nationally representative US panel were randomly assigned to make or to predict a health care decision. They were also randomly assigned to 1 of 5 recipients: themselves, a loved one 60 y or older, a loved one younger than 60 y, a distant acquaintance 60 y or older, or a distant acquaintance younger than 60 y. Hypothetical health care scenarios depicted choices between relatively safe lower-risk treatments with a good chance of yielding mild health improvements versus higher-risk treatments that offered a moderate chance of substantial health improvements. Participants reported their likelihood of choosing lower- versus higher-risk treatments, their perceptions of family and friends’ approval of risky health care decisions, and their empathy. Results: We present 3 key findings. First, made decisions involved less risk taking than predicted decisions, especially for distant others. Second, predicted decisions were similar for others and oneself, but made decisions were less risk taking for others than oneself. People predicted that loved ones would be less risk taking than distant others would be. Third, perceived social norms were more strongly associated than empathy with made and predicted decisions. Limitations: Hypothetical scenarios may not adequately represent emotional processes in health care decision making. Conclusions: Perceived social norms may sway people to take less risk in health care decisions, especially when making decisions for others. These findings have implications for improving surrogate decision making. Highlights People made less risky health care decisions for others than for themselves, even though they predicted others would make decisions similar to their own. This has implications for understanding how surrogates apply the substituted judgment standard when making decisions for patients. Perceived social norms were more strongly related to decisions than treatment-recipient (relationship closeness, age) and decision-maker (age, gender, empathy) characteristics. Those who perceived that avoiding health care risks was valued by their social group were less likely to choose risky medical treatments. Understanding the power of perceived social norms in shaping surrogates’ decisions may help physicians to engage surrogates in shared decision making. Knowledge of perceived social norms may facilitate the design of decision aids for surrogates.

Association between Sensation-Seeking Behaviors and Concussion-Related Knowledge, Attitudes, Perceived Norms, and Care-Seeking Behaviors among Collegiate Student-Athletes

There are limited data connecting personality and behavioral tendencies and traits related to concussion care-seeking/disclosure behaviors and minimal research exists surrounding the relationship between risky behaviors, sensation-seeking, and concussion-related outcomes. This study examined the association between sensation-seeking and a student-athlete’s concussion-related knowledge, attitudes, perceived social norms, and concussion care-seeking/disclosure behaviors (intention to disclose concussion symptoms, perceived control over symptom disclosure, self-removal from play due to concussion symptoms, continued play with concussion symptoms, and disclosure of all concussions at the time of injury). The current study utilized a retrospective cohort of collegiate student-athletes at a single National Collegiate Athletic Association Division I institution. Separate multivariable linear regression models estimating mean differences (MD) and 95% Confidence Intervals (CI) estimated the association between sensation-seeking and concussion knowledge, concussion attitudes, and perceived social norms. Separate multivariable binomial regression models estimating adjusted prevalence ratios (PR) and 95%CI estimated the association between sensation-seeking and intention to disclose concussion symptoms, perceived control over symptom disclosure, self-removal from play due to concussion symptoms, continued play with concussion symptoms, and disclosure of all concussions at the time of injury. All models were adjusted for sex, sport participation, and concussion history. Higher sensation-seeking was significantly associated with less favorable concussion attitudes (adjusted MD = -1.93; 95%CI = -3.04,-0.83), less favorable perceived social norms surrounding concussion (adjusted MD = -1.39; 95%CI = -2.06,-0.72), and continuing to play while experiencing concussion symptoms (adjusted PR = 1.50; 95%CI = 1.10, 2.06). Student-athletes with increased sensation-seeking could be at risk for failing to disclose a concussion, decreasing athlete safety and resulting in less optimal care post-injury. Results will inform future theory-based concussion education programs which consider behavioral tendencies and traits as well as sport culture to promote concussion care-seeking/disclosure and individualized interventions based on risky behavior engagement.

The influence of social norms varies with “others” groups: Evidence from COVID-19 vaccination intentions

The theory that health behaviors spread through social groups implies that efforts to control the pandemic through vaccination will succeed if people believe that others in their groups are getting vaccinated. But “others” can refer to many (often overlapping) groups, such as one’s family, neighborhood, city, state, or political party. These distinctions and their relationship to behavior are understudied in the social norms and public health literature. One challenge to studying them is that many factors may confound making inferences from observed relationships between perceived social norms (what people believe others do) and intended behaviors (what people themselves will do) because there are often plausible common causes for both. For example, vaccination intentions and perceptions of one’s social group’s intentions could both increase with age, since age is a known COVID-19 risk factor and people may know more people in their own age groups. We address these issues by applying a matched design that approximates pair-randomized experiments to survey data collected in the US during late fall 2020 (N = 890) and spring 2021 (N = 996). We find that a strong relationship between perceived vaccination social norms and vaccination intentions remains when controlling for a host of real risk factors as well as dimensions known to predict COVID-19 preventive behaviors even though they are not associated with risk. The strength of the relationship declines as the queried social group grows larger and more heterogeneous. The relationship for co-partisans is second in magnitude to that of family and friends among Republicans but undetectable for Democrats. Sensitivity analysis shows that these relationships could be explained away only by an unmeasured variable with large effects on both social norms perceptions and vaccination intentions (odds ratios between two and nineteen times), and a prediction from the false consensus interpretation that intentions cause perceived social norms is not supported. We discuss the implications for public health policy and understanding social norms.

“If they believe, then so shall I”: Perceived beliefs of the in-group predict conspiracy theory belief

Conspiracy beliefs are widespread and can have detrimental consequences. As perceived social norms can exert a powerful influence on individuals, we investigated the relationship between perceived conspiracy belief norms and personal endorsement, and whether others’ conspiracy belief is overestimated. In Study 1, UK university students ( N = 111) completed measures of their personal conspiracy beliefs and estimations of others’ beliefs (an in-group and an out-group they chose, and a prescribed in-group). Perceived in-groups’ belief strongly predicted personal conspiracy belief; perceived out-group’s belief did not. Studies 2 and 3 replicated these findings in a British community sample ( N = 177) and in a UK parent sample ( N = 197), focusing on antivaccine conspiracy theories. All studies demonstrated that people overestimate the conspiracy beliefs of others. This is the first demonstration of the association between perceived in-group conspiracy belief social norms and individuals’ personal conspiracy beliefs. Interventions challenging misperceived norms could be effective in reducing conspiracy beliefs.

The impact of belongingness and graphic-based emoticon usage motives on emoticon purchase intentions for MIM: an analysis of Korean KakaoTalk users

PurposeAlthough graphic-based emoticons in mobile instant messenger (MIM) services became an important revenue source for their service provider, empirical research investigating factors influencing graphic-based emoticon purchase from the consumer's perspective is insufficient. The authors explore how user's achieved belongingness (acceptance or rejection) affects graphic based emoticon usage motivations and its purchase intentions.Design/methodology/approachA structural model is used to examine the relationship among individual's overall achieved belongingness, motivation factors of graphic-based emoticon usage in MIM such as perceived usefulness, perceived enjoyment, perceived enjoyment for others, social norm and emoticon purchase intentions. The authors collected and analyzed survey data of 279 Korean KakaoTalk users.FindingsThe analysis shows that perceived acceptance/inclusion positively impacts perceived usefulness, enjoyment and enjoyment of others in graphic-based emoticon usage. Meanwhile, perceived rejection/exclusion positively impacts perceived enjoyment and enjoyment of others but negatively influences perceived social norms. Moreover, social norms and perceived enjoyment directly affect graphic-based emoticon purchase intentions. The authors also find that perceived enjoyment of others and perceived social norms in a serial causal order mediate the relationship between perceived acceptance/inclusion (and rejection/exclusion) and emoticon purchase intentions.Research limitations/implicationsAdditional research including users from other demographic groups, such as other age groups, is required to generalize our findings and to increase external validity.Originality/valueUnique implications related to the role of user's achieved belongingness and perceived enjoyment of others in graphic-based emoticon usage in purchase intentions are found.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/ 10.1108/OIR-02-2020-0036

Why Do People (Not) Engage in Social Distancing? Proximate and Ultimate Analyses of Norm-Following During the COVID-19 Pandemic

COVID-19 has had a profound negative effect on many aspects of human life. While pharmacological solutions are being developed and implemented, the onus of mitigating the impact of the virus falls, in part, on individual citizens and their adherence to public health guidelines. However, promoting adherence to these guidelines has proven challenging. There is a pressing need to understand the factors that influence people’s adherence to these guidelines in order to improve public compliance. To this end, the current study investigated whether people’s perceptions of others’ adherence predict their own adherence. We also investigated whether any influence of perceived social norms was mediated by perceptions of the moral wrongness of non-adherence, anticipated shame for non-adherence, or perceptions of disease severity. One hundred fifty-two Australians participated in our study between June 6, 2020 and August 21, 2020. Findings from this preliminary investigation suggest that (1) people match their behavior to perceived social norms, and (2) this is driven, at least in part, by people using others’ behavior as a cue to the severity of disease threat. Such findings provide insight into the proximate and ultimate bases of norm-following behavior, and shed preliminary light on public health-related behavior in the context of a pandemic. Although further research is needed, the results of this study—which suggest that people use others’ behavior as a cue to how serious the pandemic is and as a guide for their own behavior—could have important implications for public health organizations, social movements, and political leaders and the role they play in the fight against epidemics and pandemics.