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. 2021 Jun 23;21(1):1196.
doi: 10.1186/s12889-021-11200-1.

The impact of COVID-19 pandemic on the health-seeking behaviour of an Asian population with acute respiratory infections in a densely populated community

Hwee Mian Jane Tan  1   2 , Mui Suan Tan  3   4 , Zi Ying Chang  3   4 , Kee Tung Tan  3   4 , Guan Liang Adrian Ee  3   4 , Chee Chin David Ng  3   4 , Ying Khee William Hwang  5   6 , Yi Ling Eileen Koh  3 , Yan Ping Sarah Low  3 , Ngiap Chuan Tan  3   4
Affiliations

The impact of COVID-19 pandemic on the health-seeking behaviour of an Asian population with acute respiratory infections in a densely populated community

Hwee Mian Jane Tan et al. BMC Public Health. .

Abstract

Background: The COVID-19 pandemic led to the implementation of various non-pharmaceutical interventions (NPI) as the Singapore government escalated containment efforts from DORSCON Orange to Circuit Breaker. NPI include mandatory mask wearing, hand hygiene, social distancing, and closure of schools and workplaces. Considering the similar mode of transmission of COVID-19 and other pathogens related to acute respiratory infections (ARI), the effects of NPI could possibly lead to decreased ARI attendances in the community. This study aims to determine the year-on-year and weekly changes of ARI attendances across a cluster of polyclinics following the implementation of NPI.

Methods: The effect of the nation-wide measures on the health-seeking behaviour of the study population was examined over three periods: (1) 9 weeks prior to the start of Circuit Breaker (DORSCON Orange period), (2) 8 weeks during the Circuit Breaker, and (3) 9 weeks after easing of Circuit Breaker. Data on ARI attendances for the corresponding periods in 2019 were also extracted for comparison and to assess the seasonal variations of ARI. The average weekly workday ARI attendances were compared with those of the preceding week using Wilcoxon signed rank test.

Results: ARI attendances dropped steadily throughout the study period and were 50-80% lower than in 2019 since Circuit Breaker. They remained low even after Circuit Breaker ended. Positivity rate for influenza-like illnesses samples in the community was 0.0% from the last week of Circuit Breaker to end of study period.

Conclusions: NPI and public education measures during DORSCON Orange and Circuit Breaker periods appear to be associated with the health-seeking behaviour of the public. Changing levels of perceived susceptibility, severity, benefits and barriers, and widespread visual cues based on the Health Belief Model may account for this change. Understanding the impact of NPI and shifts in the public's health-seeking behaviour will be relevant and helpful in the planning of future pandemic responses.

Keywords: Acute respiratory infections; COVID-19; Health-seeking behaviour; Influenza vaccination.

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Conflict of interest statement

No competing interests to declare.

Figures

Fig. 1
Fig. 1
Rate of change in average weekly workday attendances
Fig. 2
Fig. 2
Comparison of average weekly workday attendances in 2020 with 2019. Note: Week 1 starts from 29 Dec 2019 to 4 Jan 2020. *represents p-value less than 0.05, using Wilcoxon signed rank test (2020 against 2019)
Fig. 3
Fig. 3
Rate of change in average weekly workday attendances by age groups
Fig. 4
Fig. 4
Rate of change in average weekly workday attendances by diagnosis
Fig. 5
Fig. 5
Health Belief Model. Flowchart of The Health Belief Model [28, 29]
See this image and copyright information in PMC

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