COVID-19 related stigma and health-protective behaviours among adolescents in the Netherlands: An explorative study

Abstract

The COVID-19 pandemic has forced many governments to impose social distancing measures upon its citizens, including in the Netherlands. Motivating adolescents to adhere to measures such as social distancing can be challenging, since adolescents are relatively more affected by them, while experiencing virtually no personal health benefit. In addition, the COVID-19 pandemic seems to impact the social environment of adolescents in schools, as some media sources have reported bullying and stigmatisation of students with an Asian appearance. This study aims to explore the experiences of adolescents regarding their Health-Protective Behaviour (HPB), as well as the prevalence and expression of stigma towards ethnic minorities within the context of the first wave of COVID-19 pandemic. We performed a cross-sectional mixed-methods study, including two independent online questionnaires. An adapted version of the "HPB" questionnaire (n = 528) and the "Measure of Disease-Related Stigma (MDRS)" questionnaire (n = 380), were administered to Dutch adolescents of 10-16 years old, attending primary or secondary school. Furthermore, 15 interviews were held with eight male and seven female adolescents. All data collection took place between March 17 and April 20, 2020. Results show that adolescents perceive COVID-19 as a threat to other peoples' health, rather than their own, and report adherence to public health measures in the interest of older and more vulnerable members of their community. We found no convincing evidence for widespread misinformation or stigmatising of certain ethnic groups among adolescents related to COVID-19 during this study. Participants acknowledged such behaviour happened in the early stages of the pandemic, before this study was initiated. Adolescents are a vital group for public health researchers to engage with during a pandemic, even when reaching them can be challenging.

Fig 1. Mean scores of perceived severity and perceived vulnerability (scale 1–5) regarding a COVID-19 infection, common cold, diabetes, heart attack and food poisoning.

Note: (a) Perceived severity question: How serious would you rate the following diseases? (b) Perceived vulnerability question: What are the odds that you will get these diseases within a year? Scores: 1 = not at all serious/very unlikely, 2 = not serious/unlikely, 3 = not unserious and not serious/not likely and not unlikely, 4 = serious/likely, 5 = very serious/very likely. Error bars describe 95% confidence intervals. *significance between means for a coronavirus infection compared to the four diseases, p<0.05, two-tailed.

Fig 2. Mean scores of response efficacy and self-efficacy (scale 1–4) regarding common flu, coronavirus and common cold.

Note: (a) Response efficacy question: Do you think it will help to take precautionary measures to protect yourself from “disease”? (b) Self-efficacy question: Do you think you could protect yourself from “disease”? Scores: 1 = not at all, 2 = a little bit, 3 = quite a bit, 4 = definitely. Error bars describe 95% confidence intervals. *Significance between means for a coronavirus infection compared to the two other diseases, p<0.01, two-tailed.

Fig 3. Mean scores of response efficacy and self-efficacy (scale 1–5) regarding five different precautionary measures to prevent COVID-19.

Note: Response efficacy question: Of the following precautionary measures, do you think they will help in preventing a coronavirus infection? Self-efficacy question: If the government would advise one of these following precautionary measures, would you be capable to adhere to them? Scores: 1 = certainly not, 2 = probably not, 3 = not probable and not improbable, 4 = probably, 5 = certainly. Error bars describe 95% confidence intervals.