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. Author manuscript; available in PMC: 2023 Mar 28.
Published in final edited form as: Br J Psychol. 2022 Nov 22;114(1):282–293. doi: 10.1111/bjop.12613

Risk perception and conspiracy theory endorsement predict compliance with COVID-19 public health measures

Tian Lin 1, Amber Heemskerk 1, Elizabeth A Harris 2, Natalie C Ebner 1,3,4
PMCID: PMC10046644  NIHMSID: NIHMS1881941  PMID: 36414246

Abstract

Public health measures such as spatial distancing and physical hygiene have been found effective in mitigating the spread of the coronavirus. However, there is considerable variability in individual compliance with such public health measures and factors contributing to these interindividual differences are currently still understudied. The present study set out to determine the role of risk perception and conspiracy theory endorsement on compliance with COVID-19 public health measures and explored variations in these associations across participant age and the developmental status of a country,leveraging a large multi-national data set (N = 45,772) across 66 countries/territories, collected via online survey during the early phase of the COVID-19 pandemic (between April and May 2020). Human Development Index (HDI), developed by the United Nations Development Program, was used as a proxy of a country's achievement in key dimensions of human development. Overall, higher risk perception was associated with greater compliance, particularly in individuals with greater conspiracy theory endorsement. Specifically, people from more developed countries who perceived themselves less at risk but showed stronger conspiracy theory endorsement reported the lowest compliance with COVID-19 public health measures. Findings from this study advance understanding of the interplay between risk perception and conspiracy theory endorsement in their effect on compliance with COVID-19 public health measures, under consideration of both individual-level and country-level demographic variables and have potential to inform the design of tailored interventions to fight the current and future global pandemics.

Keywords: compliance, conspiracy theory endorsement, multi-national, public health measures, risk perception

INTRODUCTION

As COVID-19 continues to pose a significant public health threat worldwide, it is critical to understand factors that contribute to an individual's willingness to comply with public health behaviours shown effective to contain viral spread. Among those effective measures to mitigate infections are spatial distancing, wearing personal protective equipment, personal hygiene and regulation on accessibility to public facilities (Courtemanche et al., 2020; MacIntyre & Chughtai, 2020). However, there are considerable interindividual differences in compliance with such public health measures. Among multiple possible influential factors, the present study examined the interplay of two factors—risk perception and conspiracy theory endorsement—on willingness to comply with public health measures to contain the spread of COVID-19. We further examined the extent to which individual age and a country's developmental status moderated these effects.

Motivations behind health-related behaviours are often complex, comprising individual as well as social, political and economic factors. Campaigns to promote health via behaviour change have been an attractive approach to disease prevention. Multiple theoretical frameworks adopting a social-cognitive perspective such as the Health Belief Model (Jones et al., 2014), the Health Action Process Approach (Schwarzer & Luszczynska, 2008), and the Protection Motivation Theory (Floyd et al., 2000) offer a foundation for effective health intervention, in examining factors such as risk perception (i.e. vulnerability, severity) and personal beliefs (i.e. self-efficacy) in their influence on the path from knowledge to precautionary behaviour.

Indeed, the perception of one's own susceptibility or vulnerability to a health risk (i.e. perceived susceptibility/vulnerability; or risk perception) is one of the critical antecedents affecting a person's willingness to engage in behaviours to reduce that risk (Champion & Skinner, 2008; Floyd et al., 2000; Schwarzer & Luszczynska, 2008; see Brewer et al., 2007 for a meta-analysis). Previous studies have provided supportive evidence for an association between risk perception and health-related behaviours in the context of pandemics, such as during the 2015 Middle East Respiratory Syndrome (MERS) pandemic (Kim & Choi, 2016). Even more relevant to the context here, greater risk perception to COVID-19 was positively correlated with preventive behaviours such as spatial distancing and hygiene (Alper et al., 2020; Hamilton et al., 2020; Lao et al., 2021; Niepel et al., 2020; Plohl & Musil, 2021). Based on this evidence, we hypothesized that greater COVID-19 risk perception would be associated with greater compliance with COVID-19 public health measures.

In addition to risk perception, individual beliefs and explanations regarding the origin of the pandemic can affect a person's willingness to engage in preventive behaviour. The role of conspiracy theory endorsement on health behaviour has been examined in the context of public health crises, such as the Zika-virus (Klofstad et al., 2019; Kou et al., 2017), anti-vaccination (Hornsey et al., 2018) and the COVID-19 pandemic (Chayinska et al., 2021; Domer & Jamieson, 2020; Hughes et al., 2022; Zelič et al., 2022). Conspiracy theories are explanations for events involving secret plots by powerful groups towards a malevolent goal (Douglas et al., 2017; van Prooijen & van Vugt, 2018). Along with the rapid spread of the virus, COVID-19 conspiracy theories received significant traction on social media and other outlets (Rathore & Farooq, 2020). Individuals with greater endorsement of conspiracy theories about the coronavirus were more likely to challenge medical experts as well as disease-preventive governmental decisions (Romer & Jamieson, 2020; see also Imhoff & Lamberty, 2018) and greater conspiracy theory endorsement was associated with less compliance with COVID-19 guidelines (Plohl & Musil, 2021; see also Freeman et al., 2022; Pummerer et al., 2021; Romer & Jamieson, 2020).

Specifically examining the link between risk perception, conspiracy theory endorsement and compliance with public health measures, individuals who were more likely to believe in COVID-19 conspiracy theories perceived the coronavirus as less dangerous and reported lower willingness to engage in preventive behaviours such as physical distancing (Chayinska et al., 2021) or wearing masks (Hughes et al., 2022), and they showed lower COVID-19 vaccination intentions (Zelič et al., 2022).

Of note, however, COVID-19 conspiracy theory endorsement does not always result in low-risk perception. Rather, some conspiracy theory contents, for example that COVID-19 is a bioweapon, may specifically highlight broader threats from the virus, and individuals may react with a particular suspicion of authorities (e.g. medical experts and governments) and be less inclined to accept health-preventive regulations recommended by those authorities. Along those lines, it has been shown, for example that endorsement of antidepressant hoax conspiracy theories reduced people's trust in the effectiveness of antidepressant treatment (Natoli & Marques, 2021; Perlis, 2018). Similarly, individuals with greater COVID-19 conspiracy theory endorsement reported lower trust in science (Chayinska et al., 2021; Zelič et al., 2022), which may result in lower willingness to follow public health guidelines, despite perception of the coronavirus as dangerous. The present study set out to specifically test the possibility that COVID-19 conspiracy theory endorsement would moderate the impact of risk perception on compliance with COVID-19 public health measures. In particular, we hypothesized that for individuals with greater endorsement of COVID-19 conspiracy theories, the association between risk perception and compliance would be reduced.

We furthermore propose that the interaction of risk perception and conspiracy theory endorsement on compliance with public health measures varies by individual's age as another individual-level predictor. This expectation is based on evidence that older compared to young adults are at enhanced risk for severe complications from COVID-19 (Jordan et al., 2020; Shahid et al., 2020). Previous work has also shown greater behavioural compliance among older than young individuals in general medical settings (Sutherland et al., 2018) and in the context of COVID-19 specifically (Brankston et al., 2021; Daoust, 2020; Lin et al., 2021; but see Clark et al., 2020). Therefore, age likely moderates the association between perceived risk, conspiracy theory endorsement and compliance with COVID-19 public health measures.

Finally, going beyond individual-level variables, country-level predictors may play a role in the interplay between risk perception, conspiracy theory endorsement and compliance with public health measures. The severity of the COVID-19 pandemic varied across countries (Hashim et al., 2020), likely affecting individual risk perceptions of its citizens. Also, the level of conspiracy theory endorsement related to the pandemic varied across countries (Georgiou et al., 2020). Previous studies have compared compliance with public health measures during the COVID-19 pandemic across a small number of countries (Al-Hasan et al., 2020). However, to date, no study has systematically examined differences in the association between risk perception, conspiracy theory endorsement and compliance with COVID-19 public health measures across multiple countries. The present study set out to fill this research gap. Understanding country-level variability of these relationships will be crucial in the design of targeted public health intervention to fight the current and future pandemics globally.

Responding to COVID-19 was a tremendous challenge which required a multitude of societal resources. The Human Development Index (HDI), created by the United Nations Development Program, constitutes a comprehensive measure of a country's overall developmental status. It considers three critical dimensions of human development: life expectancy, education and gross national income/capita (i.e. standard of living; Human Development Report, n.d.) and is therefore well-suited to depict broader-level differences in resourcefulness between countries worldwide. HDI data is publicly available with high reliability and could be retrieved for all countries/territories included in this examination. Use of HDI as a predictor in our models enhances the multi-national nature of our investigation. Given the lack of previous data, however, we did not formulate a specific directional hypothesis regarding the moderation of a country's developmental status on the interplay between risk perception, conspiracy theory endorsement and compliance with COVID-19 public health measures.

Overview

To test our hypotheses, we leveraged a large multi-national data set from 67 countries/territories (N = 46,744) that was collected during the early phase of the pandemic and span across a wide adult age range. We particularly focused on the role of risk perception to COVID-19, in interaction with COVID-19 conspiracy theory endorsement and age, as individual-level factors, on a person's willingness to comply with public health measures to contain the spread of the coronavirus. We furthermore examined the extent to which the associations between risk perception, conspiracy theory endorsement and compliance with public health measures varied across the countries' developmental status.

METHOD

For this report, we utilized data from a publicly available, large-scale, multi-national data set collected in the early phase of the COVID-19 pandemic between April and May 2020 across 66 countries/territories across a wide adult age range by a synchronized, international team of researchers (see Van Bavel et al., 2021 for details; more study details are available at https://osf.io/y7ckt/). The present study (1) examined the effects of risk perception to COVID-19 on the willingness to comply with public health measures aimed at limiting the spread of the coronavirus (Hypothesis 1); (2) determined the extent to which a person's adoption of COVID-19-related conspiracy theories moderated the association between risk perception and compliance with public health measures (Hypothesis 2); and explored variations of these relationships by (3) adult age (Hypothesis 3) and/or a country's developmental status (exploratory analysis).

Participants

The original data set comprised 46,744 individuals from 67 countries/territories. In 30 countries the samples were nationally representative (with regards to age, gender and education), in 34 countries convenience samples were recruited, and in 3 countries a combination of both sampling approaches was applied. Here, we analysed 45,772 individuals across 66 countries/territories (Min = 18, Max = 100 years, 51.96% females), as 833 individuals from Taiwan were excluded due to missing data for the country's developmental status, and an additional 139 individuals were excluded as they indicated gender as ‘other’, and our design did not have sufficient statistical power to consider this as a separate category across countries.

Procedures and measures

We report procedures and measures directly relevant for the present analysis. More details and original wording of the measures analysed here are reported in the Appendix S1.

The ethics board at University of Kent in the United Kingdom approved the protocol for the larger project, and the secondary data analysis reported here was approved by the Institutional Review Board at the University of Florida (IRB#: 202201467) and was pre-registered under https://osf.io/xf3vc/?view_only=435e981c7f4f461da2fa16b9a1b4a92e. All participants provided informed consent and then completed an online survey with measures presented in randomized order; including the ones listed below and used in the analysis in this report.

Compliance with Public Health Measures referred to spatial distancing (e.g. During the coronavirus pandemic, I have been staying at home as much as practically possible; M = 8.35, SD = 1.69, Cronbach's a = .73), physical hygiene (e.g. During the coronavirus pandemic, I have been washing my hands longer than usual; M = 7.93, SD = 1.89, Cronbach's a = .79) and policy support (e.g. During the coronavirus pandemic, I have been in favour of closing all schools and universities; M = 7.90, SD = 2.26, Cronbach's a = .87). Each of these measures comprised five items and participants gave their responses on an 11-point Likert scale (0 = Strongly disagree, 5 = Neither agree nor disagree, 10 = Strongly agree). Cronbach's a across all 15 items was .87. The average across all 15 items was computed, with higher scores reflecting greater self-reported compliance with public health measures (M = 8.09, SD = 1.58).

Risk Perception was measured by a single item ‘By April 30, 2021, how likely do you think it is that you will get infected by the Coronavirus (COVID-19)’. Participants responded to this question on an 11-point scale (0 = Impossible, 50 = Neither likely nor unlikely, 100 = Certain). Higher scores reflect greater risk percepion (M = 38.48, SD = 28.77).

Conspiracy Theory Endorsement was assessed via four items (each a different theory, that is The coronavirus (COVID-19) is a bioweapon engineered by scientists/a conspiracy to take away citizen's rights for good and establish an authoritarian government/a hoax invented by interest groups for financial gains/created as a cover up for the impending global economic crash.) on an 11-point scale (0 = Strongly disagree, 5 = Neither agree nor disagree, 10 = Strongly agree). Cronbach's a across the four items was .92. We computed the average across all four items, with higher scores reflecting greater conspiracy theory endorsement (M = 3.09, SD = 2.93).1

Age was measured via a single self-report item for chronological age in years (M = 43.08, SD = 16.05).

HDI was retrieved from http://hdr.undp.org/en/content/table-1-human-development-index-and-its-components-1 and is representative for 2019. A higher HDI score represents a higher developmental status of a country (M = 0.81, SD = 0.12).

Analyses

Multilevel modelling accommodated for the nested data structure, with individuals nested within countries (Enders & Tofighi, 2007). The outcome variable was compliance with public health measures. Level-1 predictors were risk perception, conspiracy theory endorsement, and age (both centred within country), and the level-2 predictor was HDI (grand mean centred); and their interactions were also considered. Demographic variables that were available in the data set, including gender (categorical: 0 = male, 1 = female) and self-reported socioeconomic status (continuous: 0 = have the least money, least education and the least respected jobs or no jobs, 10 = have the most money, the most education and the most respected jobs) were added as covariates.

RESULTS

Consistent with Hypothesis 1, the main effect of risk perception was significant (B = 0.002, χ2(1) = 14.62, p < .001, 95% CI = [0.001, 0.003], Cohen's f2 = 0.003), indicating that overall individuals with greater perceived risk to COVID-19 reported greater compliance with COVID-19 public health measures. This significant effect of risk perception was further qualified by an interaction between risk perception and conspiracy theory endorsement (B = 0.0006, χ2(1) = 13.09, p < .001, 95% CI = [0.0003, 0.0009], Cohen's f2 = 0.002). While this moderation effect was significant, its direction was opposite than predicted in Hypothesis 2. In particular, the positive association between risk perception and compliance with public health measures was stronger in individuals with higher conspiracy theory endorsement. In addition, the main effect of risk perception was also qualified by a two-way interaction between risk perception and HDI (B = 0.012, χ2(1) = 7.25, p = .007, 95% CI = [0.003, 0.02], Cohen's f2 = 0.0005). That is, the positive effect of risk perception on compliance with public health measures was more pronounced in countries with higher HDI. However, the two-way interaction between risk perception and age on compliance with public health was not significant (B = −9.36 × 10−6, χ2(1) = 0.11, p = .74, 95% CI = [−0.00006, 0.00005], Cohen's f2 = 0.0002).

The three-way interaction of risk perception, conspiracy theory endorsement and age was not significant (B = 6.63 × 10−6, χ2(1) = 0.47, p = .49, 95% CI = [−0.00001, 0.00003], Cohen's f2 = 0.00002). Thus, Hypothesis 3 was not supported. The three-way interaction between risk perception, conspiracy theory endorsement and HDI, however, was significant (B = 0.003, χ2(1) = 9.77, p = .002, 95% CI = [0.001, 0.006], Cohen's f2 = 0.0004), indicating that the role conspiracy theory endorsement played on strengthening the association between risk perception and compliance with public health measures was more pronounced in individuals from more developed countries. In sum, as depicted in Figure 1, for individuals who reported lower conspiracy theory endorsement (light grey lines), risk perception was not associated with compliance with public health measures across a country's developmental status. In contrast, the association between greater risk perception and greater compliance with public health measures was more pronounced for individuals with greater conspiracy theory endorsement (grey and black lines), with this effect enhanced in more developed countries (left to right in Figure 1). That is, compliance with public health measures was lowest among individuals with low-risk perception and high endorsement of conspiracy theory from well-developed countries.

FIGURE 1.

FIGURE 1

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Compliance with COVID-19 public health measures as a function of participant risk perception, participant conspiracy theory endorsement and the country's human development index (HDI). The y-axis indicates self-reported compliance with public health measures (theoretical range: 0–10; mean across the spatial distancing, physical hygiene and policy support individual scales). The x-axis indicates standard deviation from the country-centred mean of risk perception. Low (light grey), medium (grey) and high (black) conspiracy theory endorsement represent −1.5, 0 and 1.5 standard deviations, respectively, from the country-centred mean of conspiracy theory endorsement. Low, medium and high HDI reflect −1.5, 0 and 1.5 standard deviations, respectively, from the HDI grand mean. Error bars indicate 95% confidence intervals.

In addition, the three-way interaction of risk perception, HDI and age was significant (B = 0.0009, χ2(1) = 9.77, p = .001, 95% CI = [0.0004, 0.0015], Cohen's f2 = 0.0005). As illustrated in Figure 2, with advanced age, the association between risk perception and compliance with public health measures changed from negative to positive with greater developmental status of the country. In contrast, in younger ages, the positive association between risk perception and compliance with public health measures was weaker with greater developmental status of the country. The four-way interaction between risk perception, conspiracy theory endorsement, age and HDI was not significant (B = −0.00002, χ2(1) = 9.77, p = .83, 95% CI = [−0.0002, 0.0002], Cohen's f2 = 2.81 × 10−6.

FIGURE 2.

FIGURE 2

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Compliance with COVID-19 public health measures as a function of participant risk perception, age and the country's human development index (HDI). The y-axis indicates self-reported compliance with public health measures (theoretical range: 0–10; mean across the spatial distancing, physical hygiene and policy support individual scales). The x-axis indicates standard deviation from the country-centred mean of risk perception. Low (light grey), medium (grey) and high (black) age represent −1.5, 0 and 1.5 standard deviations, respectively, from the country-centred mean of age. Low, medium and high HDI reflect −1.5, 0 and 1.5 standard deviations, respectively, from the HDI grand mean. Error bars indicate 95% confidence intervals.

Besides the effects relevant to the interaction between risk perception and conspiracy theory endorsement, we observed serval other significant effects. In particular, the main effects of conspiracy theory endorsement (B = −0.09, χ2(1) = 176.89, p < .001, 95% CI = [−0.11, −0.08], Cohen's f2 = 0.04), age (B = 0.008, χ2(1) = 51.56, p < .001, 95% CI = [0.006, 0.01], Cohen's f2 = 0.009) and HDI (B = −2.98, χ2(1) = 25.26, p < .001, 95% CI = [−4.14, −1.82], Cohen's f2 = 4.41 × 10−5 were significant, in that overall individuals with greater conspiracy theory endorsement, younger age and from more develop countries, reported lower compliance with public health measures. We also found that the interaction between conspiracy theory endorsement and HDI was significant (B = −0.19, χ2(1) = 11.44, p = .001, 95% CI = [−0.30, −0.08], Cohen's f2 = 0.001), in that the negative association between conspiracy theory endorsement and compliance with public health measures was greater in more developed countries.

DISCUSSION

Public health measures such as spatial distancing, frequent hand washing and avoiding larger gatherings have been shown effective in reducing the viral spread during the COVID-19 pandemic (Chen et al., 2020; Courtemanche et al., 2020). Compliance with these measures, however, is essential for their effectiveness. Utilizing a large multi-national data set collected at the beginning of the pandemic, the present analysis demonstrates the role of risk perception, in interplay with conspiracy theory endorsement and countries' developmental status, on compliance with public health measures. The study also explored the moderating effect of age on these associations. Results from this study have the potential to advance understanding of both individual-level and country-level factors that contribute to compliance with public health measures and could facilitate the development of intervention and public health campaigns to effectively counter the current and future global pandemics.

Overall individuals with greater risk perception for COVID-19 reported greater willingness to comply with public health measures to contain the virus. This finding aligns with predictions from social-cognitive theories about health behaviour (e.g. the Health Behaviour Model; Champion & Skinner, 2008) that the greater the perception of one's personal risk, the more likely a person engages in health behaviour to reduce that risk.

We further observed that the association between risk perception and compliance with COVID-19 public health measures was stronger in older adults and more developed countries. Older adults distance themselves from their own-age group when old age is perceived as negative (Lin et al., 2017; Weiss & Freund, 2012; Weiss & Lang, 2012). Specifically, in the present context, perceptions of greater risk for severe complications from COVID-19 among older adults (Jordan et al., 2020; Shahid et al., 2020) may have enhanced older participants' negative views about their own age group and may, at the same time, have enhanced distancing from their own age group. This distancing may then have contributed to an underestimation of their personal risks from COVID-19 and may have reduced their willingness to comply with COVID-19 public health measures. Combined with evidence of more pronounced negative-age stereotypes in more educated countries and those with higher numbers of older adults (Löckenhoff et al., 2009), this impact of age identity on enhancing the association between risk perception and compliance with public health measures may explain why this effect was particularly pronounced in countries with higher HDI as found in the present study; a speculation that future research will be able to confirm.

Largely in line with previous work (Chayinska et al., 2021; Romer & Jamieson, 2020; Hughes et al., 2022; Zelič et al., 2022), overall individuals who showed greater endorsement of conspiracy theories reported lower willingness to comply with public health measures. This finding is also in accordance with previous evidence of a correlation between higher COVID-19 conspiracy theory endorsement and less frequent preventive health behaviours (Oleksy et al., 2021). Individuals who do not endorse COVID-19 conspiracy theories may place more trust in science (Plohl & Musil, 2021) and relate better to the critical importance of public health guidelines in the fight against the pandemic, also on a broader societal level (e.g. conform with societal guidelines and other members of society), and beyond one's personal risk (e.g. to reduce the risk of spreading the virus to loved ones and other individuals).

In contrast, individuals with higher conspiracy theory endorsement showed a more positive association between risk perception and public health measures compliance. It is possible that individuals who endorse COVID-19 conspiracy theories perceive individuals or institutions involved in the development or implementation of protective health measures as members of a ‘complot’, that is as a group of people who compose a conspiracy. In turn, they may be less willing to comply with advised public health measures, unless they see themselves at great personal risk from the virus. Our finding suggests, as predicted, that factors such as risk perception and conspiracy theory endorsement individually but also in tandem influence compliance with health behaviours. Social-cognitive frameworks of health-related behaviour, such as the Health Belief Model, the Health Action Process Approach and the Protection Motivation Theory, also suggest other possible predictors such as perceived severity, health motivation, self-efficacy and perceived barriers at play in a person's willingness to engage in health behaviours, the relative contributions of which on compliance during the pandemic need to be determined in future research.

The interaction between risk perception and conspiracy theory endorsement on compliance with public health measures did not vary across age. This finding is interesting, especially considering that older adults are particularly vulnerable to severe health consequences from COVID-19 (Jordan et al., 2020; Shahid et al., 2020). While the media has extensively emphasized older adults' particular risk to the COVID-19, it is possible that individuals high in conspiracy theory endorsement may question the validity of information coming from certain news channels or institutions and may not accept the particularly high risk associated with COVID-19 at advanced age.

Importantly, the interplay between risk perception, conspiracy theory endorsement and compliance with public health measures was moderated by the countries' developmental status (HDI). In particular, the moderation of conspiracy theory on the positive association between risk perception and compliance was stronger in more developed counties. Countries with higher HDI typically show a more individualism-oriented, whereas less-developed countries show a more collectivism-oriented, societal culture (Basabe & Ros, 2005; Musambira & Matusitz, 2015), which could explain the observed stronger impact of individual-level predictors like personal risk perception and conspiracy theory endorsement on compliance with public health measures. Furthermore, greater general availability and quality of medical resources may reduce individual willingness to comply with public health measures in more-developed countries, as even more severe complications from the virus could be treated more successfully in more-compared to less-developed countries.

It is also possible that differences in level of enforcement of public health regulations across countries could have contributed to our findings. In fact, a recent study used content analysis to compare public health regulations during the early phase of the COVID-19 pandemic in 10 countries and observed considerable differences in policy enforcement (Wang & Mao, 2021; Hale et al., 2021). For example, while countries such as China, the UK, Germany, South Africa and Italy implemented strict national stay-at-home orders with exceptions only under certain circumstances, countries such as South Korea and Japan were less strict by only recommending people to say at home; and Sweden did not enforce any limits and only recommended remote learning while all other countries participating in this study closed schools during the early phase of the pandemic. Perhaps less strictly governmentally enforced public health regulations enhance the influence of individual-level factors such as perceived risk and conspiracy theory endorsement on individual willingness to comply with public health measures—a hypothesis that future research will be able to test. Similarly, the role of country-level variables such as severity of the outbreak and access to health facilities in their impact on compliance with health-protective measures during the pandemic could be explored in this context.

The unique advantages from this large-scale multi-national data collection that included multiple psychological measures from a large sample across a wide variety of countries/territories worldwide, collected within a relatively short period in the early phase of the COVID-19 pandemic, demanded the use of short, simple operationalizations of constructs of interest (see Van Bavel et al., 2021; https://osf.io/y7ckt/ for details). These short measures, however, came with some psychometric limitations. For example, perception of risk for COVID-19 is a multi-dimensional construct that includes aspects related to health, finances, liberty and information (Hughes et al., 2022). The present study's operationalization of this construct in the form of a single item cannot capture the complexity of this process and the roles of different facets of risk perception on compliance with COVID-19 public health measure will need to be addressed in future extensions of this work. In addition, some established measures of conspiracy theory beliefs (such as the Belief in Conspiracy Theories Scale by Leman and Cinnirella (2013) or the Generic Conspiracist Beliefs Scale by Brotherton et al. (2013)) are well validated, but they do not directly relate to conspiracy theory endorsement about COVID-19, while the four-item scale used in this study was specifically designed for this purpose.

CONCLUSION

In conclusion, the present study documents perceived risk, conspiracy theory endorsement and a country's developmental status as factors impacting individual willingness to engage in COVID-19 public health measures. Our findings highlight the importance of both individual-level and country-level factors of compliance with public health measures in tailored interventions. Knowledge obtained in the present study could further extend to COVID-19 vaccination efforts, given evidence that conspiracy theories negatively predict intentions to be vaccinated (Bertin et al., 2020). Thus, moving forward in the fight against COVID-19, and future global pandemics, it is crucial to design data-derived intervention tailored at individuals otherwise unlikely to engage in protective health behaviours.

Supplementary Material

Appendix

Practitioner points.

  • Lower risk perception was associated with worse compliance.

  • Conspiracy theory adoption weakens relation between risk perception and compliance.

  • Effects are more pronounced in more developed countries.

  • Results highlight potential of Health Belief Model in fight against pandemic.

ACKNOWLEDGEMENTS

T. Lin, A. Heemskerk and N.C. Ebner were supported by NIH/NIA grant 1R01AG057764; E. Harris was supported by the Social Science and Humanities Research Council of Canada (752-2018-0213). We thank Dr. Jay Van Bavel for facilitating access to, and providing information about, the data set as well as constructive feedback on the analysis plan. We further appreciate the willingness of all participants to contribute to this research and all research labs involved in data collection and data management.

Funding information

National Institute on Aging, Grant/Award Number: 1R01AG057764; Social Sciences and Humanities Research Council of Canada, Grant/Award Number: 752-2018-0213; Florida Department of Health, Grant/Award Number: Edand Ethel Moore Alzheimer’s Disease Research Program Grant22A12

Footnotes

CONFLICT OF INTEREST

All authors declare no competing interest.

SUPPORTING INFORMATION

Additional supporting information can be found online in the Supporting Information section at the end of this article.

DATA AVAILABILITY STATEMENT

All measures are publicly available at the Open Science Framework (OSF) website https://osf.io/y7ckt/. Data collection was initiated in response to the COVID-19 global pandemic and started as early and to the extent that was logistically possible. The analysis plan for this report was preregistered at OSF ((https://osf.io/6yvxp/?view_only=435e981c7f4f461da2fa16b9a1b4a92e).

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Appendix
NIHMS1881941-supplement-Appendix.pdf (128.3KB, pdf)

Data Availability Statement

All measures are publicly available at the Open Science Framework (OSF) website https://osf.io/y7ckt/. Data collection was initiated in response to the COVID-19 global pandemic and started as early and to the extent that was logistically possible. The analysis plan for this report was preregistered at OSF ((https://osf.io/6yvxp/?view_only=435e981c7f4f461da2fa16b9a1b4a92e).

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