Graduate School of Communication
University of Amsterdam
Societal and Individual Factors Affecting Public Compliance with Governmental Policies in the Case of the COVID-19 Outbreak in the Netherlands
Mandy van der Plas
10912665Master’s Thesis
Master’s Programme Communication Science Track Corporate Communication Supervised by mw. dr. S.H.J. (Sandra) Jacobs
Abstract
In times of an acute crisis, governmental policies and guidelines are crucial in leading the public. This is worrying, considering that trust in the government and their policies is
continually decreasing over the years, partially due to the continuous growth of critical voices against the government in the news media. This study aims to uncover what individual and societal factors determine the levels of compliance with governmental precautions in times of a public health crisis. It does so by looking at the case of the COVID-19 outbreak in the Netherlands, by conducting a survey study (N = 319) among Dutch adults. On a societal level, it was found that media usage and governmental trust might not be as important as previous research deemed it to be. The long-hold concern that trust in the government is declining, resulting in a public refusal of following the governmental guidelines, is not as prevalent as was previously thought. Public awareness of the precautions, on the other hand, turns out to be an important factor that determines the degree to which the public follows advised precautions. On an individual level, one’s self-perceived health literacy was found to only have a small effect on levels of compliance, while one’s self-perceived risk to contract the virus has no effect at all. These findings are useful for both the academic field and governmental crisis communication practitioners by highlighting the importance of awareness of governmental guidelines and policies during these type of crises.
Keywords: governmental trust, information source usage, awareness of governmental guidelines, compliance with governmental precautions, perceived health literacy, self-perceived risk
Societal and Individual Factors Determining Compliance with Governmental Policies Through the Lens of the COVID-19 Outbreak in the Netherlands
Trust is a prerequisite for many important functions in society (Caldwell et al., 2008). For a long time, scholars have argued how trust in government in times of a public health crisis is an important impetus in citizens’ compliance with public health policies, guidelines and restrictions (Blair, Morse & Tsai, 2017; Quinn et al., 2013; Rubin et al., 2009). In times of an acute crisis, governmental policies and guidelines are crucial in leading the public (Maxwell, 2003; Helm et al., 1981). This insight is worrying, considering that trust in the government is continually decreasing over the years, partially due to the continuous growth of critical voices against the government in the news media (Earl Bennett et al., 1999; Avery, 2009; Dalton & Wattenberg, 2002) and in social media networks (Allgaier & Svalastog, 2015). The 2020 Edelman Trust Barometer, that measures trust based on competence
(delivering on promises) and ethical behaviour (doing the right thing and working to improve society), confirms these findings. Trust in governments is worryingly low on both axes, especially in comparison to public trust in businesses, NGOs and the news media (Edelman, 2020a).
Although trust has been proven to be an important determinant of public compliance with governmental guidelines during public health crises, other variables of proven
importance have oftentimes been neglected in communication research in the context of public health crises. The current study contributes to the field by investigating various factors, on both a societal and individual level, that might impact the degree of compliance with governmental regulations in times of a public health crisis. It does so by conducting a survey among Dutch adults.
On a societal level, this study looks at how information source usage, trust in the government and awareness of governmental precautions relate to compliance with these
precautions. Different types of sources have different effects on the receiver (Kaid, 2002; Tandoc & Vos, 2015), implying that receiving information through the ‘right’ sources could potentially prevent further virus outbreak from happening (Majid & Rahmat, 2013; Voeten et al., 2009). Communication and trust are inextricably linked: trust can impact the perceived quality of communication, and the other way around, communication can either boost or damage trust (Quinn et al., 2013). In the context of a public health crisis, people are inclined to trust information communicated by news media, social media actors and personal contacts, instead of information dispersed by governments (Allgaier & Svalastog, 2015). Although it has been proved that in general, the use of news media negatively impacts trust in the
government (Avery, 2009; Earl Bennett, 1999; Dalton & Wattenberg, 2002), there is a lack of research into the relationship between source usage and governmental trust in times of a pandemic. Yet, it can be very useful for communication professionals to have this insight to effectively target the audience and to ensure the trust in the government is maintained during these tumultuous times (Maxwell, 2003).
Consequently, research shows that higher levels of governmental trust significantly impact the functioning and well-being of society, especially in times of crises (Rubin et al., 2009). In contrast, a lack of trust has been proven to result in lower levels of compliance with governmental regulations (Blair, Morse & Tsai, 2017). This highlights the importance of establishing a sufficient level of governmental trust (Rubin et al., 2009) and the deadly role distrust in the government can play during public health crises (Blair, Morse & Tsai, 2017). Naturally, to follow governmentally advised precautions, people need to be aware of them first. Various studies show that awareness of governmental policies is a direct effect of media usage (Pasek et al., 2006; De Waal & Schoenbach, 2008; Chaffee & Frank, 1996; Miyamatsu et al., 2013), however, it has not yet been investigated whether awareness of
health-related policies holds relation with following them. By taking this variable into account, this study aims to fill in a gap in communication research.
On an individual level, this study takes the concept of self-perceived health literacy (SPHL) into account, which has been proven to significantly determine the selection and utilization of health information (Meppelink et al., 2019; Chen et al., 2018; Austin et al., 2012; Jhummon-Mahadnac, Knott & Marshall, 2012), but has not yet been researched in relation with governmental trust during a public health crisis. Another variable that might impact compliance with governmental guidelines on an individual level is one’s self-perceived risk (SPR) to seriously get sick by the virus, which has been proven to increase information-seeking behaviour and consequently affects how individuals act to protect their health (Ter Huurne & Gutteling, 2008; Ward, Mertens & Thomas, 1997; Weinstein, Rothman & Nicolich, 1998).
This survey study works to uncover which factors affect public compliance with governmental precautions by focussing on the COVID-19 (coronavirus) outbreak in the Netherlands, the country’s first virus pandemic of this scale and severity and “[…] the biggest crisis since the Second World War”, according to Dutch Prime Minister Rutte (Den Hartog, 2020). The social and economic impacts of this pandemic in the Netherlands affected every level of society, as everyone had to do with the protocols set out by the government. For example, people had to practice social distancing, could not leave their homes without valid reasons, and were fined when they met with over 3 people (Rijksoverheid, 2020a). Considering these far-reaching impacts, analysing the COVID-19 outbreak could provide useful insights into which factors affect public compliance with precautions advised by the Government of the Netherlands, both on an individual and societal level. This study works with the following research question:
RQ: On a societal level, how do information source usage, trust in the government and awareness of governmental precautions relate to the compliance with the governmentally advised precautions against COVID-19? On an individual level, how do one’s self-perceived
risk to contract the virus and self-perceived health literacy relate to compliance with these precautions?
Theoretical Framework
Effects of Using Different Information Sources
Communication studies often focus on "the widespread popular belief that different media have different effects" (Kaid 1981, p. 256) by arguing how a message can have various meanings when it is distributed via different media channels (Kaid, 2002; Tandoc & Vos, 2015). However, research oftentimes ignores the effects that using different information sources (rather than channels) might have. Since the arrival of social media, news media partially lost its ‘gatekeeper’ role: public actors such as organizations, NGO’s and experts can now directly reach out to the public, without the mediation of journalists and news agencies (Tandoc & Vos, 2015). These public actors, along with news media themselves, collectively moved to these social platforms, creating an omnipresence of a wide scale of public actors on various media channels simultaneously. Despite this development, there still is a lack of research into the effects using specific sources has on public compliance with governmental policies, irrespective of the used media channel (Tandoc & Vos, 2015). This study aims to contribute to the field by measuring which type of sources the participants use most often (e.g. governmental sources, new media sources, influencers or personal contacts) instead of only measuring through which channel (e.g. internet, television, radio and newspaper usage) this information is obtained. So: respondents have to indicate how often they use certain types of sources to gather COVID-19 related information instead of reporting channel usage only.
Governments must know how to effectively inform the public on how to act during a pandemic (Holmes et al., 2009; Wong & Sam, 2010). Dispersion of information through the right sources could potentially prevent further virus outbreak from happening (Majid & Rahmat, 2013; Voeten et al., 2009). For example, it has been said that receiving information in times of a public health crisis via news media, online influencers or personal contacts triggers scepticism, indirectly affecting the extent to which people follow precautionary actions against a virus (Gerwin, 2012; Majid & Rahmat, 2013). Moreover, the
aforementioned sources oftentimes tend to question the credibility of government officials and the accuracy of their motives and policies, endangering the government’s ability to protect the public health in a crisis that relies upon the public receiving and following actionable information (Gerwin, 2012, p. 642). On the other hand, those who use governmental sources tend to be more convinced of the seriousness of the health crisis, causing them to take precautions more seriously (Walter et al., 2012; Maxwell, 2003; Song & Lee, 2016). No studies were found that investigate the role of public health organizations. Considering the findings discussed in this paragraph, the following is expected:
H1: Using a) Dutch television news media, b) Dutch newspapers, c) Dutch online media, d) Dutch radio stations, e) personal contacts, and f) people on social media as information
sources is negatively related to following the advised precautions, while using g) the Government of the Netherlands and h) Dutch health organizations as information sources is
positively related to following the advised precautions
Trust in the Government
Prior research has explained governmental trust as an important prerequisite for public health communication to ‘succeed’ and for citizens to comply with public health policies, especially in times of crisis (Blair, Morse & Tsai, 2017; Quinn et al., 2013; Rubin et al., 2009; Larson & Heymann, 2010; Salmon et al., 2015; Whetten et al., 2006). (Dis)trust in the
government influences public compliance with the recommended actions (Quinn et al., 2013). For example, the 2015 measles outbreak in California has been proven to be a direct effect of distrust in governmental health organizations, causing parents to refuse to give their children the measles-mumps-rubella vaccine (Salmon et al., 2015). A similar study by Larson and Heymann (2010) in the United Kingdom found that scepticism towards the vaccine was related to “historic levels of distrust” in the British government (p. 271). More drastically, in their study on the Ebola Virus Disease outbreak in Liberia, Blair, Morse & Tsai (2017) found that those who expressed low trust in the government were unlikely to take precautions against the virus or to abide by government-mandated social distancing mechanisms to prevent a further spread of the virus. These findings give insight into the deadly effects high levels of distrust in the government could potentially have (Paek et al., 2008; Blair, Morse & Tsai, 2017).
Contrarily, higher levels of public trust in the government have been proven to lead to more successful transfers of governmental guidelines and policies (Quinn et al., 2013), proving that working on improving governmental trust can indirectly ‘save’ lives of citizens (Rubin et al., 2009). For example, it was found that trust in governmental authorities during the H1N1 influenza outbreak was positively related with adopting behaviours to prevent infection with the virus, as communicated by the government (Rubin et al., 2009). Based on these findings, I expect similar patterns to occur during the COVID-19 outbreak. Lower levels of government trust will likely lead to a public dismissal of the communicated precautions, while higher trust-levels will presumably lead to public compliance with these precautions. Therefore, I hypothesize that:
H2: There is a positive relationship between trust in the government and public compliance with the precautions against the coronavirus as advised by the Government of the
Public Compliance with Governmentally Advised Precautions
Various studies show how, during a public health crisis, information source usage affects trust in the government (Avery, 2009; Earl Bennett, 1999; Dalton & Wattenberg, 2002; Allgaier & Svalastog, 2015). Generally speaking, the growing criticism towards governments and politics in the news media decreases the public trust in the government, a phenomenon that in research has been referred to as “video-malaise” (Avery, 2009; Earl Bennett, 1999). Allgaier & Svalastog (2015) argue how facts and scientific information are oftentimes overtaken by news reports and rumours in the news media. Social media tends to further stimulate this process, resulting in a society where rumours overshadow facts. Furthermore, credibility of governmental information is affected by one’s personal contacts: people tend to believe information from people they know (Allgaier & Svalastog, 2015, p. 496), making a spread of rumours about governments more likely to occur.
Individuals that use governmental and public health organization sources normally tend to perceive the government to be transparent, indicating a high trust in the government (Song & Lee, 2016). Communication by these sources in times of a health crisis can assist the public to rapidly adjust behaviours and perceptions of risk, resulting in better compliance with governmental policies (Maxwell, 2003). Therefore, it can be assumed that using public health organizations and governmental sources will not harm public trust in the government. It can thus be assumed that the relationship between source usage and the extent to which the public follows the advised precautions is mediated by trust in the government:
H3: Both the negative relationship between using a) Dutch television news media, b) Dutch newspapers, c) Dutch online media, d) Dutch radio stations, e) personal contacts, and f) people on social media as sources as well as the positive relationship between using g) the Government of the Netherlands and h) Dutch health organizations as sources and following
the advised precautions are mediated by trust in the government, in such a way that trust in the government reinforces these relationships
However, trust in the government is presumably not the only mediator in this
relationship. People need to be aware of governmental policies before they can act on them. Research shows that awareness of governmental policies is a direct effect of media usage: regardless of the used source, consuming information positively affects awareness of societal issues and governmental policies (Pasek et al., 2006; De Waal & Schoenbach, 2008; Chaffee & Frank, 1996; Miyamatsu et al., 2013). In the context of health-information and guidelines, only the effects of receiving information from personal contacts and health institutions on awareness have been studied: these sources have been proven to increase awareness of
health-related information (Miyamatsu et al., 2013; Voeten et al., 2009). Furthermore, there is no empirical research that proves a positive relationship between awareness of- and following of governmental regulations, however, I expect that people need to actually be aware of the advised precautions against the coronavirus before they can act on them. Based on these insights, I thus expect a positive mediation by awareness in the relation between source usage and compliance with governmental precautions. In contrast with H1 and H3, where some sources are expected to negatively affect compliance with the guidelines, all sources are expected to positively affect the following of the precautions through awareness:
H4: The positive relationship between using a) Dutch television news media, b) Dutch newspapers, c) Dutch online media, d) Dutch radio stations, e) personal contacts, f) people on social media, g) the Government of the Netherlands and h) Dutch health organizations as
sources and following the advised precautions is mediated by awareness of the precautions, in such a way that awareness of the precautions reinforces this relationship
Self-Perceived Health Literacy (SPHL) and Risk (SPR) to Contract COVID-19
On an individual level, different factors might affect compliance with governmental guidelines. Firstly, someone’s SPHL (Jhummon-Mahadnac, Knott & Marshall, 2012), or “[…] the ability to access and understand appropriate sources, as well as to assess the credibility of assertions made regarding the extent to which health threats exist and effective ways to prevent and treat health conditions” (Austin et al., 2012), might impact the extent to which someone is aware of- and follows the advised precautions. Prior research demonstrated how one’s SPHL significantly impacts the search and selection of health-related information, and therewith awareness of health-related information and behaviour (Meppelink et al., 2019; Chen et al., 2018; Austin et al., 2012; Jhummon-Mahadnac, Knott & Marshall, 2012). So, a higher SPHL might indicate a higher usage of information sources, resulting in a higher awareness of precautions to protect one’s health. This higher awareness of health-related information is said to increase participation in preventive health services, resulting in an overall better health status in comparison to those with a lower health literacy (Berkman et al., 2011). Applying these findings to the COVID-19 outbreak, the following hypothesis is formulated:
H5: One’s SPHL is positively related with following the advised precautions through someone’s total information source usage first and awareness of the advised precautions
second
A second variable that might predict individual awareness of- and compliance with precautions against the coronavirus, is one’s self-perceived risk (SPR) to contract the virus. In this study, SPR will be defined as a person's beliefs about their behaviour and the
possibility of contracting the coronavirus (Cabieses et al., 2010), and the extent to which someone believes to be part of the high-risk group and, therefore, risks becoming seriously ill in the event of an infection (Rijksoverheid, 2020b). Different studies that focus on SPR find
that individuals with a higher SPR are more aware of and sensitive to messages that are intended for people to improve their health (Szklo & Coutinho, 2009; Witte & Allen, 2000; Weinstein, Rothman & Nicolich, 1998; Ward, Mertens & Thomas, 1996). Higher SPR will lead to an increase in information-seeking behaviour, making individuals more aware on what actions to take, leading to an increase in taking precautionary actions to prevent one’s health (Ter Huurne & Gutteling, 2008; Ward, Mertens & Thomas, 1997; Weinstein, Rothman & Nicolich, 1998). Based on these findings, it can be expected that:
H6: One’s SPR to contract the coronavirus is positively related with following the advised precautions through someone’s total information source usage first and awareness of the
advised precautions second
All hypotheses of this study are visualized in a conceptual model, shown in figure 1:
Methodology
Background
The questionnaire was distributed during a period of 3 days, from April 8th till April
10th. During this period, the Netherlands was on a partial lockdown, meaning that public events were forbidden, public places were closed, and measures such as social distancing were in place for the public (Rijksoverheid, 2020a). The situation was constantly revised by the government, making it plausible for these policies to suddenly change. Therefore, the data collection period was kept as brief as possible. Fortunately, during the data collection, no
changes in governmental policies occurred. However, when drawing conclusions out of the findings of this survey study, it should be taken into account that the results are a snapshot of this specific period of time. Conducting the same study in a different period of time would likely give different results. Furthermore, there might have been (newsworthy or private) events that might have had an impact on the answers of the participants, on a collective or a more individual level, affecting the reliability of this study.
Sample
The sampling units for this study are adults (18 years or older) that speak the Dutch language and live in the Netherlands. This study makes use of both a snowball and
convenience sample. I thus do not know the exact population size, making it difficult to establish a reliable threshold (Treadwell, 2016). According to Tanaka (1987), fifty
observations per latent variable will result in a reliable sample size. This study consists of 6 latent variables and, therefore, I aimed to gather at least 300 respondents. In total, 355 individuals responded to the survey. After deleting respondents that did not finish the questionnaire or did not meet the requirements, this study eventually works with a sample size of 319 respondents. Respondents were on average 36 years old (SD = 14.82). Most respondents completed secondary vocational education, such as MBO (32.3%) or higher vocational education, such as HBO (25.1%). There is a significant inequality in the number of males (35.4%) and females (64.3%) in this sample, which can be a threat to the reliability of the sample of this study. This should be taken into account when conclusions are drawn. Design
Data for this research were gathered by doing an individual, cross-sectional survey study, that was set up using Qualtrics. Doing a cross-sectional survey allows us to question large populations at a single point in time. However, online cross-sectional survey studies usually have low response rates (Treadwell, 2016). To make sure a substantial amount of
respondents is reached, a gift voucher worth 20 euros was raffled to one of the respondents as an incentive.
Participants were recruited by using non-probability convenience and snowball sampling. The survey link was shared on LinkedIn, Facebook, Twitter and Instagram, and was sent to the researcher’s acquaintances using WhatsApp and email. However, using this non-random sampling method might lead to over- or under-representation of particular groups within the population. Furthermore, because the questionnaire was distributed via social media, the exact population is unknown. Therefore, the sample is unlikely to represent the population that is being studied and generalizations out of the results of this study cannot be made.
Concerning the informed consent, all participants were informed about the goals of this study, their anonymity, and how the data would be processed. Further, the participants were given contact details of the researcher in case they had questions about the processing of the data or the research. Also, for any complaints relating to the study, participants were given contact details of the Ethics Committee on behalf of ASCoR. Participants had to agree with this information before they could start the survey.
Operationalization of Variables
Since this study focusses on COVID-19 and precautions against further spread of the virus as advised by the Government of the Netherlands, the questionnaire for this study is in Dutch (Appendix A). Below, the measures are addressed in English:
Information Source Usage. Respondents were given the following text: “Indicate how often you look up the following sources to obtain information about the coronavirus. This is only the type of source and it does not matter through which medium you consult it (e.g. online, social media, on paper, on television or radio).” Respondents then had to indicate how often they used a total of 8 different information sources by using a 7-point Likert-type
scale, ranging from 1) Never to 7) Several times per day. Furthermore, the respondents were asked the following question: “Do you use the sources below to obtain information about the coronavirus? Please select all the sources that apply to you.” It was chosen to ask this
additional question instead of adding the options to the former list due to the survey length: I did not want respondents to drop out because of the large number of questions. Also, the answer options that are shown in this question were expected to not be used as much as the other sources. This measurement has originally been used by Austin, Fisher Liu & Jin (2012), however, the items in the measurement are adjusted to sources that are more relevant in the COVID-19 outbreak (Edelman, 2020b). All the used items and the findings can be found in table 1 in the result section. The variable “Information Source Usage” was computed by taking the mean score to test the serial mediation in hypotheses 5 and 6, that looks at the total effect of using information sources instead of the effects of using separate sources (M = 4.42, SD = 1.08).
Following Precautions. To measure to what extent respondents follow precautions against the coronavirus, I made a list of the recommendations as communicated by the Government of the Netherlands (Rijksoverheid, 2020a), which can be found in table 2 in the result section. Participants were asked to what extent they apply the measures in their daily lives, using a 5-point Likert-type scale ranging from 1) Never to 5) Always. Then, the
variable “Following Advised Precautions” was computed by taking the mean score to test the hypotheses of this study (M = 4.42, SD = 0.42).
Awareness of Precautions. I asked respondents to rate the statement: “I am aware of all precautions currently in force against the coronavirus, as communicated by the
Government of the Netherlands” on a 7-point Likert-type scale, ranging from 1) Completely disagree to 7) Completely agree (M = 6.33, SD = 1.00).
Self-Perceived Risk (SPR). Respondents had to rank the following statement: “I consider myself as belonging to the vulnerable group (for example because of my age, health, or contact with sick people in my work)” by using a 7-point Likert-type scale, ranging from 1) Completely disagree to 7) Completely agree (M = 3.05, SD = 1.97). This measure has previously been used by I&O Research & Universiteit Twente (2020).
Self-Perceived Health Literacy (SPHL). The World Health Organisation (WHO) describes health literacy as “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health” (2020). Based on this understanding of the WHO and a conceptualization of health literacy as described by Osborne et al. (2013), a scale was created to measure one’s SPHL in the context of the coronavirus outbreak. The scale consisted of the following items: “I know where to find reliable information on the coronavirus”; “I
understand how to use information about the coronavirus to protect my health”; and “When I do not understand information about the coronavirus, I have loved ones who can help me understand it”. Respondents used a 7-point Likert-type scale ranging from 1) Completely disagree to 7) Completely agree.
A principle axis factor (PAF) shows that only one component has an eigenvalue above 1 (eigenvalue 1.94) and there is a clear point of inflexion after this point on the scree-plot. These 3 items thus indeed form a single uni-dimensional scale, and these factors together explain 64.59% of the variance in the original items. After a direct oblimin rotation, all items correlate positively with the first factor. The item "I know where to find reliable information on the coronavirus" has the strongest association (factor loading is .85). Reliability of the scale is acceptable, Cronbach's alpha = .68. Therefore, it appears the scale measures SPHL (M = 6.09, SD = 0.75)
Trust in Government. 7 items were used to measure trust in the Government of the Netherlands. Participants used a 7-point Likert scale, ranging from 1) Strongly disagree to 7) Strongly agree. The items measured respondents’ attitudes towards openness, honesty, commitment, caring and concern, and competence of the government in addressing the coronavirus; the extent to which participants believed the government's actions in response to the coronavirus were in their personal interest; and how much participants believed the government would protect them from the coronavirus. This scale has been used and verified by Quinn et al. (2013, p. 97). A principle axis factor (PAF) shows that these items indeed form a single uni-dimensional scale: only one component has an eigenvalue above 1
(eigenvalue 3.83) and there is a clear point of inflexion after this point on the scree plot. The factors together explain 54.71% of the variance in the original items. After a direct oblimin rotation, all items correlate positively with the first factor. The item measuring perceived governmental honesty has the strongest association (factor loading = .81). Reliability of the scale is good, Cronbach's alpha = .85 (M = 5.53, SD = 0.90).
Results
Table 1 shows an overview of the findings for the independent variable information source usage by Dutch adults during the coronavirus outbreak. Dutch television news (M = 5.40, SD = 1.50) and personal contacts (M = 5.11, SD = 1.88) were the most used sources to obtain information about COVID-19 during the data collection period. The least used sources were Dutch public health organizations (M = 3.64, SD = 1.85) and Dutch radio stations (M = 3.70, SD = 2.29).
Considering the findings for public compliance with governmentally advised precautions against the coronavirus (table 2), it stands out that respondents followed these precautions quite well (M = 4.42, SD = 0.42). Within this variable, there are no major differences between the items.
Information Source Usage and Following of Precautions
To find out whether information source usage is related to the following of
was conducted. The model proves to be statistically significant, F(8, 130) = 2.26, p = .023, and can thus be used to predict how well respondents follow the advised precautions. However, the strength of the prediction is small: variance of information source usage predicts only 5.5% of following of the advised precautions (R2 = .055).
As can be seen in table 3, only the usage of Dutch health organizations as an
information source has a statistically significant effect on following the advised precautions. Only H1h can thus be accepted: all other sub-hypotheses of H1 will be rejected. This means that in this sample, no direct relation could be found between usage of any of the information sources and following the advised precautions against the coronavirus, except for using Dutch health organizations as an information source. However, even though there is a
positive and significant relation between using Dutch health organization sources and following the advised precautions, this association is weak, b* = .17.
Trust in the Government and Following The Advised Precautions
To test whether trust in the government is related to the extent to which the public follows the precautions against COVID-19 as advised by the Government of the Netherlands, a simple regression analysis was conducted. The regression model was statistically
significant, F(1, 137) = 4.35, p = .038. Variance in trust in the government predicts 1.4% of following the advised precautions, indicating a small prediction (R2 = .014). More
specifically, trust in the government is positively related with following the advised
precautions, b* = .11, t = 2.09, p = .038, 95% CI [0.00, 0.11], indicating a weak association between the two variables. Therefore, I accept H2, implying that there is a positive
relationship between governmental trust and following of the precautions in this sample. Trust in the Government and Awareness of the Precautions as Mediators between Source Usage and Following the Advised Precautions
This study hypothesizes that the relationship between information source usage and the degree to which one follows the advised precautions against COVID-19 is parallelly mediated by the variables trust in the government and awareness of the precautions, in such a way that these mediators reinforce the direct relationship. As seen in H1, only the use of Dutch health organizations as a source has a statistically significant effect on the degree to which respondents follow the advised precautions against COVID-19. Therefore, I will only test whether this specific relationship is mediated by trust in the government and awareness of the precautions.
This parallel mediation was tested by using model 4 of the Hayes PROCESS macro in SPSS. Firstly, the relationship between using Dutch health organizations as an information source and trust in the government is not statistically significant, t = 1.62, 95% CI [-0.01, 0.10] (Figure 2). The association between trust in the government and following the advised precautions is not significant either, t = 1.30, 95% CI [-0.02, 0.08] (Figure 2). These findings indicate that trust in the government does not mediate the relationship between using health organizations as an information source and following the precautions in this sample. H3 must thus be rejected.
Awareness of the precautions, on the other hand, does partially mediate the relationship between using health organization sources and following the advised
precautions. Both the relation between using health organizations as a source and awareness of the precautions, t = 2.15, 95% CI [0.01, 0.13], and between awareness of the precautions and following the advised precautions, t = 3.36, 95% CI [0.03, 0.12], are positive and statistically significant (Figure 2). There is a significant indirect effect of using Dutch health organizations as an information source on following the advised precautions through
be partially accepted. Although awareness of the precautions does positively partially mediate the relation between using health organization sources and following the advised precautions, the direct effect between X and Y (b = .03) decreases when awareness is taken into account (b = .005), indicating that this mediator is not a reinforcer like was hypothesized.
SPHL, SPR and Following the Advised Precautions
Model 6 of the Hayes PROCESS macro in SPSS was used to test the relationships between SPHL and following the advised precautions (H5) and between SPR and following the advised precautions (H6) through information source usage first, and awareness of the precautions second. Both the regression model for H5, F(1, 137) = 7.01, p = .009, and H6, F(1, 137) = 6.30, p = .013, are statistically significant and can thus be used to test these hypotheses.
Firstly, for H5, SPHL had a significant positive effect on following the advised precautions (t = 3.58, 95% CI [0.05, 0.17]) (Figure 3). Contrary to what was theorized, this effect is only partially mediated by awareness of the advised precautions, of which both the effects between SPHL and awareness (t = 4.67, 95% CI [0.20, 0.49]) and between awareness of- and following of the advised precautions (t = 2.89, 95% CI [0.02, 0.11]) are significant. The effect between SPHL and information source usage (t = 2.65, 95% CI [0.05, 0.36]) was
significant, however, both the effect between source usage and awareness (t = .43, 95% CI [-0.08, 0.12]) and between source usage and following the advised precautions (t = .68, 95% CI [-0.03, 0.06]) were not significant. Therefore, H5 cannot be supported. This means that there is no serial mediation by information source usage first and awareness of the precautions second between SPHC and following the advised precautions: this relationship is only mediated by awareness of the precautions.
Secondly, for H6, figure 4 shows us that the direct effect between risk perception and following the precautions (t = 1.63, 95% CI [-0.00, 0.04]) is not significant. Considering the hypothesized serial mediation (by information source usage first and awareness of the precautions second), only the relationships between SPR and information source usage (t = 2.51, 95% CI [0.02, 0.13]) and between awareness of- and following the advised precautions (t = 3.89, 95% CI [0.04, 0.13]) are significant. The relation between information source usage and following the precautions (t = .92, 95% CI [-0.02, 0.06]), source usage and awareness (t = 1.13, 95% CI [-0.05, 0.17]), and risk perception and awareness (t = -.35, 95% CI [-0.07, 0.05]), are all insignificant. Therefore, H6 must be rejected: the total indirect effect of this model is insignificant.
Discussion and Conclusion
Although previous work found that (a lack of) trust in the government is an important determinant of public’ compliance with governmental guidelines during public health crises (Blair, Morse & Tsai, 2017; Quinn et al., 2013; Rubin et al., 2009), to date, there has been a gap in public health crisis communication research that looks whether other factors might impact compliance with these regulations as well. This study, therefore, aimed to uncover which factors affect compliance with governmental guidelines during a public health crisis on both a societal and individual level. It did so by focussing on the coronavirus outbreak in the Netherlands, a pandemic of unprecedented scale and severity on both a social and economic level. The findings of the survey suggest that overall, the respondents followed the advised precautions to a high degree. On a societal level, both a higher trust in the government and using Dutch public health organization sources positively affected this compliance with governmental precautions, however, both these effects were rather small. Using other source types did not affect the degree of following the precautions. Awareness of the precautions partially mediated the direct relation between using health organization sources and following the precautions, while governmental trust did not mediate this effect. Moreover, on an
individual level, one’s SPHL affected compliance with the precautions through awareness of the precautions. No effect was found for one’s self-perceived risk.
It is striking that on a societal level, information source usage seems to have no impact on compliance with governmental guidelines. Media usage is deemed an important determinant of public behaviour in times of a public health crisis (Tandoc & Vos, 2015; Voeten et al., 2009; Gerwin, 2012; Majid & Rahmat, 2013; Walter et al., 2012; Maxwell, 2003; Song & Lee, 2016), however, the findings of this study suggest that the effects of media usage are not as substantial during a public health crisis. This can perhaps be explained by the scale and severity of the COVID-19 pandemic, “[…] the biggest crisis since the
Second World War”, according to Dutch Prime Minister Rutte (Den Hartog, 2020). It is apprehensible that people did not want to risk getting sick, considering that there was still a lot of uncertainty about the details of the coronavirus during the data collection period of this study (Rijksoverheid, 2020a). The findings of this study verify this presumption, considering that all respondents followed the advised precautions to a high degree. Although media source usage considerably impacts public behaviour in ‘normal’ situations, this effect may fall insignificant in times of a global pandemic and joint insecurity: additionally, the critical stance against governmental policies (Avery, 2009; Dalton & Wattenberg, 2002; Allgaier & Svalastog, 2015) might temporarily stagnate due to these fears for the unknown effects of the new virus.
Moreover, the findings of this study suggest that although media sources do not directly affect public compliance with guidelines, as researchers oftentimes argue (Tandoc & Vos, 2015; Maxwell, 2003), there actually is an effect of source usage on behaviour through awareness of the precautions. This makes sense, since media are important in informing the public about governmental policies first (Holmes et al., 2009; Wong & Sam, 2010; Voeten et al., 2009). Although media do influence public perceptions and behaviour, their primary role is to inform the public - there needs to be a level of societal and political awareness among the public before they can actually adjust their behaviour (Voeten et al., 2009). It has not yet been investigated whether awareness of health-related policies holds relation with following them - other studies in this field oftentimes neglect the concept of awareness. This study, therefore, fills a gap in communication research by showing that awareness might have been a latent mediator in these studies, explaining for the direct effect between source usage and behaviour. This finding opens new perspectives for research, and for governmental
increase public awareness to indirectly improve public compliance with governmental regulations.
Another remarkable finding in this study challenges the widespread belief that public trust in the government is an impetus for compliance with governmentally advised
precautions (Blair, Morse & Tsai, 2017; Rubin et al., 2009; Larsson and Heymann, 2010; and Salmon et al., 2015). Although this effect was found, it was remarkably small, demonstrating that the societal effects of lower levels of public trust in the government during a pandemic might not be as drastic as has previously been thought. Again, this might be explained by the high levels of uncertainty around the coronavirus during the data collection period of this study (Rijksoverheid, 2020a), which might have played a part in numbing the common critical vision on the government (Allgaier & Svalastog, 2015). Consequently, this might have caused lower levels of governmental distrust, making the public more compliant with the advised precautions, just like the findings of this study indicate.
Another explanation of this finding can perhaps be found in the measurement of trust in the government, which specifically focussed on trust the Government of the Netherlands with explicit regards to the coronavirus outbreak. Measuring trust in the government in a more general manner might have provided different results. Besides, this study only offers a snapshot in time of an early phase in the virus outbreak in the Netherlands: conducting the same study in a later timeframe likely ends up giving different results.
Lastly, by including the concepts of self-perceived health literacy (SPHL) and risk (SPR) in this research, new views on individual factors determining compliance with
guidelines have been explored. One’s level of SPHL affects awareness and compliance with precautions (Meppelink et al., 2019; Chen et al., 2018; Austin et al., 2012; Jhummon-Mahadnac, Knott & Marshall, 2012), although the found effect was unexpectedly small. Presumably, the measurement of the variable explains for this finding: respondents were
asked to indicate how knowledgeable they were concerning the coronavirus specifically, instead of their SPHL in general. Future research might benefit from investigating the effects of one’s overall SPHL, instead of only measuring one’s SPHL concerning the disease in question.
Even more remarkable it that SPR does not affect compliance with governmentally advised precautions at all, other than previous studies suggested (Ter Huurne & Gutteling, 2008; Ward, Mertens & Thomas, 1997; Weinstein, Rothman & Nicolich, 1998).
Contemplating the communication about COVID-19 by experts and governments might partially explain this, since in the early phases of the coronavirus outbreak, the public was explicitly warned that older people and individuals with chronic diseases had higher risks of contracting the virus (Rijksoverheid, 2020b). Respondents of this study were on average only 36 years old, which is quite young – so, presumably, there were only a few older respondents or respondents that had chronic diseases who saw themselves as belonging to the high-risk group, explaining the insignificant findings for SPR. Moreover, the government specifically stated that the public should follow the precautions to prevent further spread of the virus (Rijksoverheid, 2020b). Questioning respondents about their perceived risk of spreading the virus to people belonging to the high-risk group, instead of the SPR of contracting the virus themselves, might therefore have given more useful insights.
Further research should be conducted to verify the effects of these individual factors. When these findings are consistent among other populations, this might imply that
governments benefit from increasing health literacy on a public level, for example by early-on health educatiearly-on. Making sure the public has an overall higher health literacy might consequently make them more aware of the health policies during a virus outbreak or pandemic, causing them to act more in line with the advised precautions.
Limitations
Though the current study offers new insights to the governmental crisis
communication literature, several limitations should be discussed. First, the data collection happened during a period wherein the social situation was still very tumultuous. Even though the collection period was kept as brief as possible and was finalized after 3 days, in which no massive societal changes took place, it might still be possible that personal- or smaller societal changes took place that affected the reliability of this study. Also, this research only offers a snapshot in time – conducting the same study using the same respondents in a different time frame would probably bring us different outcomes, affecting the reliability. Another limitation concerns the measurement of information source usage, which targets how often respondents use a certain source type. However, it might have been difficult for respondents to report their actual source usage. For example, 2 persons that watch a press conference by Prime Minister Mark Rutte, broadcasted by Dutch broadcast organization NOS, might report their source usage in a different manner. One of them might report the Government of the Netherlands as the used source, since he or she directly listens to the Prime Minister, while the other person thinks that the used source type was the Dutch news media since the press conference was aired by a news organization. The scale that is being used here might thus need some adaption to enhance its credibility.
Lastly, the measurement of awareness of the precautions possibly lacked in reliability. This study simply asked participants to indicate how aware they were of the governmental measures in force at that point of time, however, these answers might differ from the actual awareness of the respondents. Future research should work to create a more reliable scale to measure awareness of governmental precautions.
This study gained valuable insight into public compliance with governmental
Netherlands. It did so by focussing on both individual and societal determinants of compliance. The findings of this investigation are useful for both the academic field and governmental crisis communication practitioners by highlighting the importance of
awareness of governmental guidelines and policies during these type of crises. The long-hold concern that trust in the government is declining, resulting in a public refusal of following the governmental guidelines, is minimal – even though this effect does occur, it is not as
prevalent as was previously thought. However, this study is only exploratory, and further investigation of the relation between the concepts studied in this paper is recommended for follow-up research.
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Appendix A
Geachte heer, mevrouw,
U bent uitgenodigd deel te nemen aan een onderzoek dat wordt uitgevoerd onder
verantwoordelijkheid van de Graduate School of Communication, onderdeel van de afdeling Communicatiewetenschap van de Universiteit van Amsterdam. Door deel te nemen aan dit onderzoek, maakt u kans om een cadeaubon ter waarde van €20,- voor de webwinkel bol.com te winnen!
Het doel van dit onderzoek is om meer te weten te komen over de relatie tussen mediagebruik en de naleving van de voorzorgsmaatregelen tegen verspreiding van het coronavirus
(COVID-19) zoals gecommuniceerd door de Nederlandse overheid. Dit onderzoek wordt georganiseerd door Mandy van der Plas, Masterstudente Corporate Communication aan de Universiteit van Amsterdam. Het onderzoek zal ongeveer 10 minuten van uw tijd in beslag nemen.
Omdat dit onderzoek wordt uitgevoerd onder de verantwoordelijkheid van ASCoR, Universiteit van Amsterdam, heeft u de garantie dat:
1. Uw anonimiteit is gewaarborgd en dat uw antwoorden of gegevens onder geen enkele voorwaarde aan derden zullen worden verstrekt, tenzij u hiervoor van tevoren
uitdrukkelijke toestemming hebt verleend.
2. U zonder opgaaf van redenen kunt weigeren mee te doen aan het onderzoek of uw deelname voortijdig kunt afbreken. Ook kunt u achteraf (binnen 24 uur na deelname) uw toestemming intrekken voor het gebruik van uw antwoorden of gegevens voor het onderzoek.
3. Deelname aan het onderzoek geen noemenswaardige risico’s of ongemakken voor u met zich meebrengt, geen moedwillige misleiding plaatsvindt, en u niet met expliciet aanstootgevend materiaal zult worden geconfronteerd.
4. U uiterlijk 5 maanden na afloop van het onderzoek de beschikking over een
onderzoeksrapportage kunt krijgen waarin de algemene resultaten van het onderzoek worden toegelicht
Voor meer informatie over dit onderzoek en de uitnodiging tot deelname kunt u te allen tijde contact opnemen met de projectleider: mandy.vanderplas@student.uva.nl.
Mochten er naar aanleiding van uw deelname aan dit onderzoek bij u toch klachten of opmerkingen zijn over het verloop van het onderzoek en de daarbij gevolgde procedure, dan kunt u contact opnemen met het lid van de Commissie Ethiek namens ASCoR, per adres: ASCoR secretariaat, Commissie Ethiek, Universiteit van Amsterdam, Postbus 15793, 1001NG Amsterdam; 020-525 3680; ascor-secr-fmg@uva.nl. Een vertrouwelijke behandeling van uw klacht of opmerking is daarbij gewaarborgd.
Wij hopen u hiermee voldoende te hebben geïnformeerd en danken u bij voorbaat hartelijk voor uw deelname aan dit onderzoek dat voor ons van grote waarde is.
Met vriendelijke groet, Mandy van der Plas
1. Wat is uw leeftijd? In cijfers, bijvoorbeeld: 25*
________________________________________________
* Wanneer de respondent jonger dan 18 is, wordt de survey direct beëindigd
2. Bent u momenteel woonachtig in Nederland?* o Ja
o Nee
* Wanneer de respondent niet woonachtig is in Nederland, wordt de survey direct beëindigd
3. Wat is uw geslacht? o Vrouw o Man o Anders
o Wil ik liever niet zeggen
4. Wat is de nationaliteit waarmee u zich identificeert? o Nederlands
o Anders, namelijk ________________________________________________
5. Wat is uw hoogst afgeronde opleidingsniveau? Dus: waar u een diploma voor heeft behaald o Geen opleiding
o Basisonderwijs
o Middelbare school (VMBO, HAVO, VWO, Gymnasium) o Middelbaar beroepsonderwijs (MBO of vergelijkbaar) o Hoger beroepsonderwijs (HBO of vergelijkbaar) o Wetenschappelijk onderwijs (WO of vergelijkbaar)
6. Geef aan hoe vaak u de volgende bronnen opzoekt om informatie over het
coronavirus te verkrijgen. Het gaat hier alleen om de soort bron en het maakt niet uit via welk medium u deze bron raadpleegt (dus bijvoorbeeld online, via social media, op papier, op televisie of op de radio).
Schaal: 1) Nooit
2) Eens per maand, of minder 3) Twee of drie keer per maand 4) Wekelijks
5) Minstens drie keer per week 6) Dagelijks, een keer per dag
Bronnen:
o Informatie van de Rijksoverheid of regering
Zoals rijksoverheid.nl, persconferenties, social media kanalen van politici (zoals Mark Rutte of Martin van Rijn), of ministeries (zoals de website of social media kanalen van het Ministerie van Volksgezondheid, Welzijn en Sport), Kamerdebatten, et cetera
o Nationale gezondheidsorganisaties Zoals de website of social media kanalen van het RIVM
o Nederlandse televisie nieuwsmedia
Zoals het Journaal, RTL Nieuws, of talkshows zoals Jinek, Op1, M, et cetera. Deze bronnen kunnen zowel op televisie als online worden geraadpleegd (bijvoorbeeld op Uitzending Gemist, websites of via social media
o Nederlandse kranten
Kranten zoals het AD, de Volkskrant, de Telegraaf, NRC. Deze bronnen kunnen zowel in print als online worden geraadpleegd (bijvoorbeeld op websites van de krant of op social media).
o Nederlandse online nieuwsmedia
Nieuwskanalen die enkel online beschikbaar zijn, zoals NU.nl o Nederlandse radiozenders
Radiozenders zoals 538 Nieuws en BNR Nieuwsradio. Deze bronnen kunnen zowel op de radio als online worden geraadpleegd (bijvoorbeeld op websites van de zender of op social media)
o Personen op sociale media
Dit antwoord heeft géén betrekking op social media berichten van nieuwsmedia, overheidsinstanties of uw persoonlijke contacten. Hier wordt gedoeld op bronnen die
enkel te vinden zijn op online- of social media, zoals Instagram-, Twitter-, YouTube-, Snapchat-, TikTok-, blog- of Facebookberichten van bijvoorbeeld bekende
Nederlanders, influencers, vloggers, bloggers, meme-accounts of accounts zoals RUMAG en Dumpert (bronnen die grappige teksten, foto's en/of video's plaatsen), et cetera
o Persoonlijke contacten
Zoals toegezonden informatie via WhatsApp, social media, sms, telefoon, of het horen van informatie in 'real-life' van familie, vrienden, collega's, buren, kennissen, et cetera
7. Maakt u gebruik van onderstaande bronnen om informatie over het coronavirus te verkrijgen? Selecteer alle bronnen die voor u van toepassing zijn.
o Lokale overheidsbronnen
Zoals persconferenties van de burgemeester, de website van jouw gemeente, social media kanalen van lokale politici, et cetera
o Internationale gezondheidsorganisaties
Zoals de website of social media kanalen van de World Health Organization (WHO) o Lokale nieuwsmedia Zoals televisie- of radiozenders, kranten en social media kanalen van plaatselijke of regionale nieuwsorganisatie van bijvoorbeeld RTV West, AD/Rotterdams Dagblad, AT5, Leidsch Dagblad, Katwijk Actueel, Friesch Dagblad o Buitenlandse nieuwsmedia Zoals televisie- of radiozenders, kranten, websites en social media kanalen van bijvoorbeeld BBC, NY Times, Fox News, National Public Radio, Al Jazeera, Buzzfeed.
o Anders:________________________________________________
8. Geef aan in hoeverre u het met de volgende uitspraken eens bent:
Schaal:
o Helemaal oneens o Oneens
o Een beetje oneens o Neutraal
o Een beetje eens o Eens
o Helemaal eens
Statements:
o Ik beschouw mijzelf als behorend tot de kwetsbare groep (bijvoorbeeld door mijn leeftijd, weerstand, of contact met zieken in mijn werk)
o Ik ben op de hoogte van alle momenteel geldende maatregelen tegen het coronavirus, zoals gecommuniceerd door de Nederlandse overheid
9. In hoeverre hanteert u de volgende maatregelen omtrent het coronavirus in het dagelijks leven?
Schaal: o Nooit o Bijna nooit
o Vaak o Altijd
Statements:
o Ik vermijd handen schudden met anderen
o Ik was mijn handen regelmatig met water en zeep
o Ik blijf thuis als ik last heb van neusverkoudheid, hoesten, keelpijn of koorts o Ik draag gezichtsmaskers als ik mijn huis uit moet
o Ik gebruik papieren zakdoekjes om mijn neus te snuiten en gooi deze daarna direct weg
o Ik houd mij aan 'social distancing' en blijf zo veel mogelijk thuis o Ik 'hamster' voeding en huishoudelijke producten
o Ik gebruik antibacteriële handgel
o Ik hoest en nies in de binnenkant van mijn elleboog
o Als iemand in mijn gezin of huishouden koorts heeft, blijf ik ook thuis o Ik desinfecteer mijn neus en/of keel met een desinfecterend middel o Ik vermijd contact met groepen van 3 of meer personen
o Ik houd 1,5 meter afstand van anderen
o Ik vermijd contact met ouderen en mensen met een verminderde weerstand (voor zover mijn werk dit toelaat)
10. Onderstaande woorden hebben betrekking op berichtgeving over het coronavirus door de Nederlandse (Rijks)overheid (bijvoorbeeld in persconferenties van
op de websites of besluiten van de Ministeries, uitspraken van leden van de Tweede Kamer, of het beleid dat de overheid momenteel voert rondom COVID-19).
In hoeverre voldoet de communicatie van de Nederlandse overheid volgens u aan de volgende kenmerken?
Schaal
o Helemaal oneens o Oneens
o Een beetje oneens o Neutraal
o Een beetje eens o Eens o Helemaal eens Kenmerken o Transparant o Eerlijk o Betrokken o Zorgzaam o Bezorgd
11. Geef aan in hoeverre u het eens bent met de volgende uitspraken:
Rutte, uitspraken van ministers op social media of in het nieuws, berichten op de websites of besluiten van de Ministeries, uitspraken van leden van de Tweede Kamer, of het beleid dat de overheid momenteel voert rondom COVID-19.
Schaal:
o Helemaal oneens o Oneens
o Een beetje oneens o Neutraal
o Een beetje eens o Eens
o Helemaal eens
Statements:
o De reacties van de Nederlandse overheid op het coronavirus zijn in het eigen (politiek) belang. Dus: om hier zelf van te profiteren.
o De Nederlandse overheid doet er alles aan om het volk te beschermen tegen het coronavirus.
12. Geef aan in hoeverre de volgende uitspraken op u van toepassing zijn:
Schaal:
o Helemaal oneens o Oneens
