Public perceptions and preventive behaviours during the early phase of the COVID-19 pandemic: a comparative study between Hong Kong and the United Kingdom.

BACKGROUND: Given the public health responses to previous pandemics of respiratory diseases, and in the absence of treatments and vaccines, the mitigation of Coronavirus Disease 2019 (COVID-19) relies on population engagement in non-pharmaceutical interventions. Engagement is largely driven by risk perception, anxiety level and knowledge, as well as historical exposure to disease outbreaks, government responses and cultures. OBJECTIVE: To compare psycho-behavioral responses in Hong Kong (HK) and the United Kingdom (UK) during the early phase of the pandemic. METHODS: Comparable cross-sectional surveys were administered among adults in HK and the UK during the early phase of each respective epidemic. Explanatory variables included demographics, risk perception, knowledge of COVID-19, anxiety level and preventive behaviors. Responses were weighted according to census data. Logistic regression models, including effect modification to quantify setting differences, were used to assess the association between explanatory variables and the adoption of social-distancing measures. RESULTS: Data of 3431 complete responses (HK:1663; UK:1768) were analysed. Perceived severity differed by setting (HK: 96.8%; UK: 19.9%). A large proportion of respondents were abnormally/borderline anxious (HK:60.0%; UK:46.5%) and regarded direct contact with infected individuals as the transmission route of COVID-19 (HK:94.0-98.5%; UK:69.2-93.5%), with HK identifying additional routes. HK reported high levels of adoption of social-distancing (HK:32.6-93.7%; UK:17.6-59.0%) and mask-wearing (HK:98.8%; UK:3.1%). The impact of perceived severity and perceived ease of transmission on the adoption of social-distancing varied by setting. In HK, they had no impact, whereas in the UK, those who perceived severity as "high" were more likely to adopt social-distancing (aOR:1.58-3.01), and those who perceived transmission as "easy" were prone to both general social-distancing (aOR:2.00, 95% CI:1.57, 2.55) and contact avoidance (aOR:1.80, 95% CI: 1.41, 2.30). The impact of anxiety on adopting social-distancing did not vary by setting. CONCLUSIONS: These results suggest that health officials should ascertain baseline levels of risk perception and knowledge in the populations, as well as prior sensitisation to infectious disease outbreaks, during the development of mitigation strategies. Risk communication should be done through suitable media channels - and trust should be maintained - while early intervention remains the cornerstone of effective outbreak response. CLINICALTRIAL: Not applicable.