How the Stringency of the COVID-19 Restrictions Influences Motivation for Adherence and Well-Being: The Critical Role of Proportionality

Int J Health Policy Manag. 2023:12:8021. doi: 10.34172/ijhpm.2023.8021. Epub 2023 Oct 10.

Abstract

Background: The stringency of the measures taken by governments to combat the COVID-19 pandemic varied considerably across countries and time. In the present study, we examined how the proportionality to the epidemiological situation is related to citizens'behavior, motivation and mental health.

Methods: Across 421 days between March 2020 and March 2022, 273,722 Belgian participants (Mage = 49.47; 63.9% female; 33% single) completed an online questionnaire. Multiple linear mixed regression modeling was used to examine the interaction between the epidemiological situation, as indicated by the actual hospitalization numbers, and the stringency index to predict day-to-day variation in the variables of interest.

Results: Systematic evidence emerged showing that disproportional situations, as opposed to proportional situations, were associated with a clear pattern of maladaptive outcomes. Specifically, when either strict or lenient measures were disproportional in relation to the epidemiological situation, people reported lower autonomous motivation, more controlled motivation and amotivation, less adherence to sanitary rules, higher perceived risk of infection, lower need satisfaction, and higher anxiety and depressive symptoms. Perceived risk severity especially covaried with the stringency of the measures. At the absolute level, citizens reported the highest need satisfaction and mental health during days with proportional lenient measures.

Conclusion: Stringent measures are not per se demotivating or compromising of people's well-being, nor are lenient measures as such motivating or enhancing well-being. Only proportional measures, that is, measures with a level of stringency that is aligned with the actual epidemiological situation, are associated with the greatest motivational, behavioral, and mental health benefits.

Keywords: Epidemiology; Motivation; Policy; Proportionality; Risk Perception; Well-Being.

MeSH terms

  • COVID-19* / epidemiology
  • COVID-19* / prevention & control
  • Female
  • Government
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Motivation*
  • Pandemics