Monitoring knowledge, risk perceptions, preventive behaviours and trust to inform pandemic outbreak response.

The study is part of the large project promoted by WHO Regional Office for Europe called “Monitoring knowledge, risk perceptions, preventive behaviours and trust to inform pandemic outbreak response” and carried out in over 30 countries of the WHO European Region (Registered ISRCTN on 11/05/2021, ID: ISRCTN26200758). In Italy, the survey was conducted administering an online questionnaire developed ad hoc by the WHO in four waves (January-May 2021) to a sample of 10.000 individuals aged 18-70 years. A detailed sampling plan was developed to obtain a representative sample of the Italian adult population. The following variables were taken into account for stratification of the participants: gender by age (four age groups: 18-34 years, 35-44 years, 45-54 years, 55-70 years); geographical area (four areas: North West, North East, Centre, South and Islands); size of living centers (two classes: above and below 100,000 inhabitants); level of education (up to lower middle school, beyond lower middle school); and employment situation (employed, not employed). At the end of each survey’s wave, a weighting procedure has been applied to accurately restore the proportionality of the total sample examined with the reference population, according to the most recent data of the Italian Statistics Institute (ISTAT, 12/31/2019). In particular, data have been weighted for the main socio-demographic and geographic variables (e.g., sex by age by geographical area, occupation, educational qualification, geographical area by size of living centers). The sample size made it possible to maintain a sampling error of less than 2% (at the significance level of 95%) and to control the error of estimates within groups or subgroups of interest. The interviews were conducted by Doxa S.p.a. and carried out with the CAWI technique (Computer Assisted Web Interviewing) on an online panel and on the Confirmit software platform used by Doxa S.p.a. The average administration time was about 18-20 minutes. This study was approved by the Ethics Committee of the IRCCS San John of God Fatebenefratelli of Brescia (n° 72-2020), and all participants provided written informed consent.

The primary objectives are to:

● Monitor variables that are critical for population behaviour to control transmission of the novel coronavirus, including risk perceptions, knowledge, self-efficacy, confidence in institutions, behaviours, rumours, affect, worry, resilience, trust in/use of information sources and more.
● Document changes over time in these factors to understand the effect of the pandemic process, new developments, events or measures taken.
● Monitor possible issues, e.g. related to misinformation or distrust, as they emerge, to allow early response.
● Identify relationships between variables to identify levers for effective and appropriate responses.
● Explore the relationship of psychological variables (e.g. worry, resilience, trust, affect) with the epidemiological situation and the events and measures taken.
● Identify gaps between perceived and actual knowledge.
● Evaluate the effectiveness of pandemic response measures, and the acceptance and effectiveness of policies and restrictions implemented, including the easing of such restrictions.
The secondary objectives are to:
● Contribute to post-outbreak evaluation, thereby contributing to the continued regional/global efforts to better understand mechanisms of crisis response.
● If additional research capacity is available, the data can be triangulated with data on media reporting, COVID-19 cases and other.● If additional research capacity is available, the data can be triangulated with data on media reporting, imported or confirmed cases, etc.: The relationship between psychological variables and characteristics of the outbreak situation can be explored (i.e. how closely the perceived risk mirrors reported cases, relative import risk, media reports).
This approach allows a citizen-centred approach where insights into population perceptions and behaviours inform COVID-19 actions, alongside epidemiological data and considerations of economic, cultural, ethical, structural political nature and other.

The WHO questionnaire includes 21 different thematic areas noteworthy for the investigation of COVID-19 experience. The questionnaire was translated into specific country language by each recruiting site, following the WHO’s guidelines for translations of tools into other languages. The process included the following steps: forward translation, panel experts, back-translation, pre-test and cognitive interviews and, finally, development of the final version. Variables being surveyed include the following:
• Socio-demography;
• COVID-19 personal experience;
• Health literacy;
• COVID-19 risk perception;
• Probability and Severity;
• Preparedness and Perceived self-efficacy;
• Prevention – own behaviours;
• Affect;
• Trust in sources of information;
• Use of sources of information;
• Frequency of Information;
• Trust in institutions (perceptions);
• Policies, interventions (perceptions);
• Conspiracies (perceptions);
• Resilience (perceptions);
• Testing and tracing;
• Fairness (perceptions);
• Lifting restrictions (pandemic transition phase);
• Unwanted behaviour;
• Wellbeing;
• COVID-19 vaccine.