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Changes in Precautionary Health Behaviour during COVID-19

New SHARE study finds that elderly people with chronic diseases show higher levels of cautious health behaviour during the pandemic and keep their cautiousness over time compared to healthy people

(August 2021) To protect people from infection, COVID-19 related policy restrictions across Europe urged citizens to take precautionary steps with varying levels of stringency from hand sanitizing and wearing masks to staying at home. As vaccine resources were not available for a long time and are still limited, peoples´ behaviour and commitment are key elements in pandemic containment. A new study with data from the Survey of Health, Ageing and Retirement in Europe (SHARE) analysed time patterns of precautionary health behaviour of people aged 50+ during summer 2020. During this time, governments eased the restrictions due to decreasing infection and mortality rates. The researchers Bíró, Branyiczki and Elek investigated divergences in the level of willingness to take precautionary steps and discovered that health behaviour differs by the presence of chronical diseases considered as risk factors for COVID-19 such as hypertension and heart diseases.

Analysing time trends in precautionary health behaviour across Europe with SHARE-COVID19 data

The researchers analysed data from the SHARE Corona Survey conducted between June and August and data from SHARE Wave 7 from over 46.000 individuals from 26 European countries and Israel. They investigated if cautious health behaviour spread or faded over time during the pandemic and if there are differences based on health status. The study draws a specific focus on people aged 50+ due to the high mortality risk. Especially for elderly people with chronic diseases it is important to understand dynamics of different health behaviours to protect this vulnerable group.

Precautionary health behaviour is driven by individuals’ subjective cost-benefit analysis

To determine how people changed their health behaviour in response to the outbreak of the pandemic, Bíró et al. analysed indicators such as taking a walk, meeting family/others, wearing mask and hand washing/sanitising. Based on theory it can be assumed that individual drivers of health behaviour are the perceived probability of getting infected as well as the health risk of an infection, which influence the risk aversion. Based on a subjective cost-benefit analysis people rate indicators as costlier (i.e., associated with more effort) (e.g. giving up meeting family/others) and less costly (e.g. hand washing). Furthermore, the perceived health risk is influenced by objective risk factors such as age and chronic diseases.

Most respondents took over precautionary health behaviour during the pandemic

The results show that hand washing and sanitising were performed by the majority of respondents and seem to be the least costly interventions. 85% of respondents washed their hands and used hand sanitizer more than usual after the start of the pandemic. 76% of respondents always kept distance and 59% always wore a mask in public. 53% stayed at home or did not visit other family members and 63% did not meet more than five people outside the household since the outbreak. The most drastic changes in health behaviour - never leaving home for a walk and shopping since the outbreak - were reported by 31% and 27%, respectively.

Protective behaviour decreased during summer 2020

On average, people became less cautious during the analysed period. A gradual loosening of the behavioural changes during summer is especially visible for meeting family/others and keeping distance. Decreasing patterns could be a result of less restrictive policy measures, the decrease of COVID-19 related death cases as well as changing risk attitudes and risk perceptions of individuals. In contrast, the amount of people who always wear a mask in public or use sanitiser increased, showing that the least costly behaviours are the most persistent over time.

Individuals with higher health risk due to chronic conditions are generally more cautious

66,5% of respondents had a higher health risk due to the presence of a chronic disease. In total, people with chronic conditions were more cautious and kept their cautiousness during summer compared to healthy people. The indicator “no meeting with family/others” for example decreased in summer by 9-10% for the healthy and only by 5% for people with chronic diseases. Individuals with a higher health risk were more likely to maintain even the costly precautionary steps over time, especially people aged 70+. The main differences in precautious behaviour by health status can be observed for walking, shopping and meeting family/others, while they are negligible for hand washing and sanitising. In total, people with higher risks are on average more careful in all European countries. Further, people in Western and Northern Europe were on average the least cautious during the time period, especially in going for walks, shopping, meeting family and wearing masks.

Importance of assessing health behaviour during the COVID-19 pandemic

The study shows time trends and differences in precautionary health behaviour by health status across Europe. On average, people became less precautious during the easing phase of the pandemic in summer 2020, but this is less so for those who are at higher risk due to chronic diseases. Vulnerable people take more efforts to avoid infection. Changing the behaviour of people and maintaining protective behaviour are key elements for pandemic development until the majority of people is vaccinated.


Study by Anikó Bíró, Réka Branyiczki and Péter Elek (2021). Time patterns of precautionary health behaviours during an easing phase of the COVID-19 pandemic in Europe. SHARE Working Paper Series 57-2021. Doi: 10.17617/2.3289111

URL: http://www.share-project.org/share-publications/share-working-paper-series.html

Photo: Adobe Stock / oatawa