Background
Methods
The study context
Population and procedures
Interview guide development
Analysis
Results
No | Gender | Age | Education and occupation | City |
---|---|---|---|---|
1. (pilot) | F | 32 | Physiotherapist, temporarily laid off | Western city and the Netherlands |
2 | F | 67 | Nurse, retired | Eastern city |
3 | M | 67 | Engineer, retired | Small western city |
4 | M | 49 | Master’s degree, computer engineer | Western city |
5 | F | 79 | Nurse, manager, retired | Western city |
6 | F | 65 | Nurse assistant, retired | Eastern town |
7 | F | 19 | First-year university student | Northern city |
8 | F | 19 | First-year university student | Northern city |
9 | F | 19 | First-year university student and kindergarten assistant | Northern city |
10 | M | 27 | High school education, NGO worker | Northern city |
11 | M | 37 | High school education, firefighter | Small southern city |
12 | M | 32 | Airline pilot, temporarily laid off | Small southern city |
13 | M | 51 | Farmer, agronomist | Western town |
14 | M | 34 | Chef, offshore worker | Small eastern city |
15 | M | 22 | Electrician | Western town |
Virus transmission | Risk mitigation | Consequences of COVID-19 |
---|---|---|
Comprehending modes of virus transmission | Affecting exposure to risk | Building situational awareness |
Understanding terms differently | Learning about mitigation in different ways | Perceiving personal health consequences differently |
Acting on uncertain evidence | Being driven by symbolic values | Emphasising secondary consequences |
Virus transmission
Comprehending modes of virus transmission
You do not have to have contact through body fluids to get it, so you do not have to drink from the same water bottle to get it. You can get it through breathing the same air. If you are infected, you exhale corona particles, and then I can breathe in and be infected that way. But now I am very insecure. This is where I have actually gotten mixed messages (No. 9, Female, 19 years old).
How do we get infected? How is it happening? So that you know how to be safe. Droplet infection, for example, is it enough to just turn away? Do you have to wear a face mask or just keep your mouth shut there and then? (No. 6, Female, 65 years old).
Understanding terms differently
Terminology | Descriptions |
---|---|
Droplet transmission | People with COVID-19 emit droplets and particles from their noses and mouths that contain SARS-CoV-2 |
Contact transmission | Transmission occurs either directly through contact with a contagious person (for example, by a hug or handshake) or indirectly through contact with other surfaces contaminated with viruses (door handles, light switches, handrails) |
Airborne transmission | Tiny virus-containing droplets/particles from the nose and mouth of an infectious person remain suspended in the air for a long time and move over longer distances |
Acting on uncertain evidence
Because it’s so cold here, I can see how big the breathing cloud is [outdoors]. It is far behind that person, and then I think if there are any droplets of virus in that cloud, one metre of distance is way too little… You cannot expect that everyone should work in a surgical theatre to understand this, but it’s not difficult to comprehend when you get it visualised like this (No. 6, Female, 65 years old).
I read online that it failed to stay alive for more than three days, but it could just be something people have written online, and I knew I could not trust it…I think it can be transmitted through food. I feel insecure when grocery shopping. For example, when I pick up clementines in the store, usually I just put them in a bowl in the living room, but now I wash the clementines before I put them in the living room because, I mean, there can be a little virus on them even if I have to peel them, and then it gets on my fingers. There are so many things I touch, and I think we are not careful enough when we buy food (No. 5, Female, 79 years old).
Risk mitigation
Affecting exposure to risk
How much risk do I take if I go to the cinema? How risky is it to go ice skating on our lake? If I know that it is not wise to go ice skating there, then I might keep more distance. There are often such things someone does not quite know yet. More research is needed, or it [spread of infection] just has to happen, and then there will be results. When you do not know, it turns out that you just act and don’t think. One does not know what is worse than other things (No. 1, Female, 32 years old).
This virus does not seem to disappear. Then, everyone needs to be able to assess the risk in the situation and make their own choices because that is what society is used to. It is life threatening, and we all make our own choices on where we take risks and where we do not take risks. That is the normal situation. This is not just a matter of sitting still in the boat until the storm is over. There are waves on the sea all the way, so we have to learn to navigate through the waves… I can make many safe choices without having to lock down my whole life and just sit inside a room if I had more knowledge about the kinds of situations in which infections occur (No. 4, Male, 49 years old).
Learning about mitigation in different ways
I think it is very important that people understand why it is important to keep your distance, why it is important to wear a face mask because if you understand the reason why you should act the way you act, then it will be a little easier to keep your distance. I do it because the infection rates have to go down (No. 7, Female, 19 years old).
It is easier to rely on information that has been verified from several sources to understand the motivations of those who provide the information. I appreciate clear and in-depth information, and that it is really the web and things that are published from official sources, and of course, you have to take it for what it is. But then you have the opportunity to assess it. If it comes in a Snapchat message, it would not have helped me very much. I prefer real, verifiable information, and I would rather have it written than in videos (No. 4, Male, 49 years old).
I would like information on how they think I should keep one metre away on a bus because when you sit right in front of someone, it is not one metre. You have to try around rush hour, but it’s a bit difficult. You structure the day about the same as others (No. 8, Female, 19 years old).
Being driven by symbolic values
What to do, it’s a feeling you get. If you’re in a shop, you disinfect your fingers, and you may not have touched anything, and then you go into a new store, and you disinfect your fingers again. I feel that’s maybe done more for the public, those around me. But it is based on how I look at people who do not do the same because I do not know if they have been to any other places before. So you kind of feel that you are a bit obliged to do it, even if you have already done it. But it is to set an example and show that you do it yourself (No. 11, Male, 37 years old).
Consequences of COVID-19
Building situational awareness
First and foremost, it is important to really understand the seriousness, and that happened when we went into lockdown. Then, you understood quite quickly that this is not really the flu. It’s a little more serious (No. 8, Female, 19 years old).
If too many of us become ill, the more people will need intensive care and a respirator. I think the authorities are most afraid of the burden on the healthcare system. This is the major consequence that we see from other countries. I think the authorities are very concerned about keeping control so that we do not have a burden in society where ambulances have to stand in line to get patients in (No. 2, male, 67 years old).
Perceiving personal health consequences differently
What I miss most is information about the long-term effects of getting COVID-19 because I know nothing about it. I know what I am supposed to do, or really, I know quite a lot about what I should do, but I don’t know anything about the long-term damage for the younger population. If we could also get long-term damage from it, then I think people would have taken it even more seriously (No. 14, Male, 34 years old).
I don’t want information about personal health consequences. I feel like I know it’s [COVID-19] very dangerous. I have seen the documentary Helene Checks In from a corona ward. After that, I was really scared. Since then, we have been almost completely isolated because it was absolutely cruel. It’s worse than COPD. They cannot breathe more than one way, and I saw the panic in their eyes when they tried to talk. It’s a terrible disease (No. 6, Female, 65 years old).The Helene Checks In documentary made me think that it could have been very serious, especially if I was older, or for my parents because then I could see the outcome for older patients, especially an older man. He seemed very nice and upbeat, but he could not breathe and talk due to his respiratory problems. It made me think of my family then (No. 10, Male, 27 years old).
Emphasising secondary consequences
What’s important is that the wheels keep going because being a farmer and a gardener, the biological processes go on continuously, whether its corona or not. The plants are growing, and the cows need to be milked (No. 13, Male, 51 years old).
This is rough for single people, and they don’t have to be old. Many who have kids at home and try to manage this, they are having a hard time. And not to get out and touch a living human being is tough. I have some unmarried and widowed friends. They cannot even touch a man. That’s actually what life is about (No. 5, Female, 79 years old).
If I see people coughing, I turn away. I stay away from people who have even small symptoms of disease, even though I have to admit that I have had my grandchildren over for visit with symptoms. I think it’s just a little cold. It is a qualified choice I make then. I understand that I am exposing myself to risk. When the minister of health said we should not be with grandchildren, I thought that I cannot stand a year without cuddling with my grandchildren (No. 2, Female, 67 years old)
Comparation between the lay model and the expert model
NIPH messages | Public perceptions, actions and ways of learning |
---|---|
Virus transmission modes Relevant transmission modes: • droplets • air • contacts | Variably mentioned: • droplets • air • or/and contact Also mentioned: • food • clothes • faeces |
Dominant transmission route • Droplet transmission most likely/significant • Airborne transmission and contact transmission exist but are nonsignificant | • Most did not separate between probable/less probable routes of transmission • Believed in multiple equal important ways of transmission |
Symptomatic, asymptomatic, presymptomatic spread • Can be infected with and transmit SARS-CoV-2 virus without developing COVID-19 • Can be symptomatic carriers with COVID-19 • People with COVID-19 are most contagious for 1–2 days before the onset of symptoms and in the first days after the onset of symptoms | • Emphasise symptomatic transmission • Being sick without symptoms not mentioned by most but emphasised as vital to understand why you should keep distance and quarantine |
Terminology • Terminology used on website: contact transmission, droplet transmission, airborne transmission | • Terms not used by most of the participants • Terms understood differently • Talked about transmission in relations to behaviours for how transmission occurred: • spitting • hugging • kissing • touching • talking |
Virus survival • The virus can survive on surfaces from a few hours to several days • Depends on the amount of virus, temperature, sunlight, and humidity • The role that virus survival on surfaces plays in causing infection in humans is uncertain and constantly changing • Poorly ventilated rooms increase the concentration of particles containing the virus | • Acted on evidence from informal sources, e.g., three-day survival on surfaces • Few mentioned wind, climate and ventilation affected virus spread • Many wanted more knowledge about how far droplets spread and how long they could survive in the air |
Basic infection prevention measures • Maintain social distancing, have fewer contacts, maintain hand hygiene and cough etiquette and use of face masks when not able to keep a distance | • All were informed about the main mitigation measures • Some people wanted to understand why certain behaviour and activities were considered high risk, others preferred simple, clear messages explaining what to do and how to protect themselves • Some sought informal sources to better comprehend the why • Easily accessible, up-to-date online information • Need someone to explain and interpret restrictions • Sometimes enacting mitigation measures was a symbolic action |
Safe distance • The amount of virus exposed at distances of more 1–2 m would rarely be sufficient to cause infection • Mainly infected within 1–2 m reach from infected person • Keep one metre of distance • The greater that the distance that you keep is, the less that the probability is that you will be exposed to infection | • None of the participants talked in terms of probabilities • One of the participants misunderstood the 1-m rule as a clear boundary between safe and unsafe distances • Did not understand why 1 m and not 2 m |
Risky activities • Risky activities due to increased expulsion of aerosols and/or being close to others are ◦ Pubs ◦ Travelling ◦ Exercise centres ◦ Poorly ventilated rooms | • Increased risk of being physically close to others was well understood • Struggling to understand why some activities were not allowed • Some wanted information about risky situations and risky localisations |
Protecting others • The virus is possibly deadly for the oldest and some groups of people with chronic diseases | • All participants understood their collective responsibility to protect others |
Contagiousness • The R-number is how many persons that one corona infected person infects further • A person infected with the coronavirus infects an average of 2–3 others, while one person with the flu infects 1–2 others | • COVID-19 contagiousness was underestimated by all of the participants • To comprehend the contagiousness of the virus, they had to understand that this disease was not influenza |
Control of the spread • The R-value was communicated in terms of numbers, but exponential growth was not explained to the public | • The R-number was perceived as a good indicator regarding the control of the spread • The R-number was often misunderstood • No one understood exponential growth correctly |
Consequences of the pandemic • NIPH communicated the health effects for the individual | • After one year with pandemic restrictions, most emphasised secondary consequences (e.g., economy, mental health) • Information about health consequences produced panic in some interviewees and awareness in others • There were daily trade-offs between social life and the risk of becoming ill |