Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep;27(3):1119-1152.
doi: 10.1111/bjhp.12591. Epub 2022 Mar 23.

"We want to live a little longer and our family want[s] us around": A summative content analysis of adherence to COVID-19-related guidelines using the Theoretical Domains Framework

Jessica Z Leather  1   2 , Chris Keyworth  3 , Tracy Epton  1 , Joanna Goldthorpe  1 , Fiona Ulph  1 , Christopher J Armitage  1   2   4
Affiliations

"We want to live a little longer and our family want[s] us around": A summative content analysis of adherence to COVID-19-related guidelines using the Theoretical Domains Framework

Jessica Z Leather et al. Br J Health Psychol. 2022 Sep.

Abstract

Objective: Public adherence to COVID-19-related government guidance varied during the initial lockdown in the UK, but the determinants of public adherence to such guidance are unclear. We capture spontaneous reflections on adherence to UK government guidance from a representative UK sample, and use the TDF to identify key determinants of COVID-related behaviours.

Design: The design was cross-sectional.

Methods: Qualitative data were collected from a large sample of UK adults (N = 2,252) via an online questionnaire as part of a wider survey about the UK public's responses to the government's COVID-19-related guidance. Summative content analysis was used to identify key guideline terms in the data, followed by latent analysis to interpret the underlying meanings behind the terms using the TDF as an analytical framework.

Results: Six TDF domains were identified in the data: Environmental Context and Resources; Beliefs about Consequences; Social Influences; Memory, Attention and Decision Processes; Emotion; and Knowledge. Although the samples were motivated and capable of adhering, limitations in their environments, resources, and social support mechanisms restricted behaviour. Self-reported adherence was sensitive to positive and negative beliefs about the effectiveness of the measures, in addition to interpretations of the terms 'essential' and 'necessary' in the guidance.

Conclusions: Despite extensive structural obstacles to adherence, the majority of the British public were able to follow government COVID-19-related instructions, provided they had sufficient resources, social support, and positive perceptions about the effectiveness of the measures. Ambiguities surrounding key terminology in the guidance left room for interpretation, which may have contributed to non-adherence.

Keywords: COVID-19; Theoretical Domains Framework; adherence; government guidance; summative content analysis.

PubMed Disclaimer

Conflict of interest statement

JZL reports grants from NIHR Greater Manchester Patient Safety Translational Research Centre; CJA was supported by NIHR Manchester Biomedical Research Centre.

Figures

Figure 1
Figure 1
Facilitators and barriers from 498 statements presented by TDF domain
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Armitage, C. J. , Keyworth, C. , Leather, J. Z. , Byrne‐Davis, L. , & Epton, T. (2021). Identifying targets for interventions to support public adherence to government instructions to reduce transmission of SARS‐CoV‐2. BMC Public Health, 21(1), 522. 10.1186/s12889-021-10574-6 - DOI - PMC - PubMed
    1. Atchison, C. , Bowman, L. R. , Vrinten, C. , Redd, R. , Pristerà, P. , Eaton, J. , & Ward, H. (2021). Early perceptions and behavioural responses during the COVID‐19 pandemic: a cross‐sectional survey of UK adults. British Medical Journal Open, 11(1), e043577. 10.1136/bmjopen-2020-043577 - DOI - PMC - PubMed
    1. Atkins, L. , Francis, J. , Islam, R. , O’connor, D. , Patey, A. , Ivers, N. , … Michie, S. (2017). A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implementation Science, 12(1), 77. 10.1186/s13012-017-0605-9 - DOI - PMC - PubMed
    1. Beeckman, M. , De Paepe, A. , Van Alboom, M. , Maes, S. , Wauters, A. , Baert, F. , … Poppe, L. (2020). Adherence to the physical distancing measures during the COVID‐19 pandemic: A HAPA‐based perspective. Applied Psychology: Health and Well‐Being, 12(4), 1224–1243. 10.1111/aphw.12242 - DOI - PubMed
    1. Benham, J. L. , Lang, R. , Kovacs Burns, K. , MacKean, G. , Léveillé, T. , McCormack, B. , … Marshall, D. A. (2021). Attitudes, current behaviours and barriers to public health measures that reduce COVID‐19 transmission: A qualitative study to inform public health messaging. PLoS One, 16, e0246941. 10.1371/journal.pone.0246941 - DOI - PMC - PubMed

Publication types