Historical narratives about the COVID-19 pandemic are motivationally biased.

How people recall the SARS-CoV-2 pandemic is likely to prove crucial in future societal debates on pandemic preparedness and appropriate political action. Beyond simple forgetting, previous research suggests that recall may be distorted by strong motivations and anchoring perceptions on the current situation1-6. Here, using 4 studies across 11 countries (total n = 10,776), we show that recall of perceived risk, trust in institutions and protective behaviours depended strongly on current evaluations. Although both vaccinated and unvaccinated individuals were affected by this bias, people who identified strongly with their vaccination status-whether vaccinated or unvaccinated-tended to exhibit greater and, notably, opposite distortions of recall. Biased recall was not reduced by providing information about common recall errors or small monetary incentives for accurate recall, but was partially reduced by high incentives. Thus, it seems that motivation and identity influence the direction in which the recall of the past is distorted. Biased recall was further related to the evaluation of past political action and future behavioural intent, including adhering to regulations during a future pandemic or punishing politicians and scientists. Together, the findings indicate that historical narratives about the COVID-19 pandemic are motivationally biased, sustain societal polarization and affect preparation for future pandemics. Consequently, future measures must look beyond immediate public-health implications to the longer-term consequences for societal cohesion and trust.

Empirical evidence to understand the human factor for effective rapid testing against SARS-CoV-2.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapid antigen point-of-care and home tests are available to laypeople. In four cross-sectional mixed-methods data collections conducted between December 2020 and March 2021 (n = 4,026), we showed that a majority of subjects were willing to test despite mistrust and ignorance regarding rapid tests' validity. Experimental evidence shows that low costs and access to events could increase testing intentions. Mandatory reporting and isolation after positive results were not identified as major barriers. Instead, assuming that testing and isolation can slow down the pandemic and the possibility to protect others were related to greater willingness to get tested. While we did not find evidence for risk compensation for past tests, experimental evidence suggests that there is a tendency to show less mask wearing and physical distancing in a group of tested individuals. A short communication intervention reduced complacent behavior. The derived recommendations could make rapid testing a successful pillar of pandemic management.

Heatwaves and their health risks: knowledge, risk perceptions and behaviours of the German population in summer 2022.

Heatwaves are becoming more common and impact health. We conducted a representative survey in June 2022 in Germany to determine people's knowledge and protective behaviours on heat days. In data from 953 respondents, we found that a large proportion informed themselves about upcoming heat days, but there are considerable gaps in knowledge. While knowledge was not related to taking up protecting behaviour, other predictors were (e.g. risk perception). Health campaigns should therefore not only aim to improve knowledge but also address risk perceptions, facilitate social learning, communicate social norms and remove barriers that prevent protective behaviours.

Explaining Boomerang Effects in Persuasive Health Communication: How Psychological Reactance to Healthy Eating Messages Elevates Attention to Unhealthy Food.

While psychological reactance is often invoked to explain the unintended boomerang effects of persuasive health messages, underlying processes that might explain how reactance affects behavior are rarely studied. We investigated whether messages that elicit reactance can bias attention by increasing the perception of information that potentially facilitates adverse behavior. Participants (N = 998) were assigned to one of three experimental conditions: reading an aggressive and emotional text asking them to stop eating meat (appeal condition); reading a neutral text about the nativeness and benefits of eating less meat (information condition); or completing an unrelated word count task (control condition). After assessing their reactance, participants were asked to identify as many words as possible in a word grid in which some words related to meat. Compared to the other conditions, the appeal condition elicited the greatest reactance. Furthermore, omnivore participants in this condition identified significantly more meat-related words when they reported higher levels of reactance. By showing that psychological reactance elicited by forceful health appeals increases attention to information that may facilitate the admonished behaviors, our findings contribute to an improved understanding of effective health communication.

Social and behavioral consequences of mask policies during the COVID-19 pandemic.

Mandatory and voluntary mask policies may have yet unknown social and behavioral consequences related to the effectiveness of the measure, stigmatization, and perceived fairness. Serial cross-sectional data (April 14 to May 26, 2020) from nearly 7,000 German participants demonstrate that implementing a mandatory policy increased actual compliance despite moderate acceptance; mask wearing correlated positively with other protective behaviors. A preregistered experiment (n = 925) further indicates that a voluntary policy would likely lead to insufficient compliance, would be perceived as less fair, and could intensify stigmatization. A mandatory policy appears to be an effective, fair, and socially responsible solution to curb transmissions of airborne viruses.

Ok Google: Using virtual assistants for data collection in psychological and behavioral research.

Because of the increasing popularity of voice-controlled virtual assistants, such as Amazon's Alexa and Google Assistant, they should be considered a new medium for psychological and behavioral research. We developed Survey Mate, an extension of Google Assistant, and conducted two studies to analyze the reliability and validity of data collected through this medium. In the first study, we assessed validated procrastination and shyness scales as well as social desirability indicators for both the virtual assistant and an online questionnaire. The results revealed comparable internal consistency and construct and criterion validity. In the second study, five social psychological experiments, which have been successfully replicated by the Many Labs projects, were successfully reproduced using a virtual assistant for data collection. Comparable effects were observed for users of both smartphones and smart speakers. Our findings point to the applicability of virtual assistants in data collection independent of the device used. While we identify some limitations, including data privacy concerns and a tendency toward more socially desirable responses, we found that virtual assistants could allow the recruitment of participants who are hard to reach with established data collection techniques, such as people with visual impairment, dyslexia, or lower education. This new medium could also be suitable for recruiting samples from non-Western countries because of its wide availability and easily adaptable language settings. It could also support an increase in the generalizability of theories in the future.

Allocation of COVID-19 vaccination: when public prioritisation preferences differ from official regulations.

As vaccines against COVID-19 are scarce, many countries have developed vaccination prioritisation strategies focusing on ethical and epidemiological considerations. However, public acceptance of such strategies should be monitored to ensure successful implementation. In an experiment with N=1379 German participants, we investigated whether the public's vaccination allocation preferences matched the prioritisation strategy approved by the German government. Results revealed different allocations. While the government had top-prioritised vulnerable people (being of high age or accommodated in nursing homes for the elderly), participants preferred exclusive allocation of the first available vaccines to medical staff and personnel caring for the elderly. Interestingly, allocation preferences did not change when participants were told how many individuals were included in each group. As differences between allocation policies and public preferences can affect trust in the government and threaten the social contract between generations, we discuss possible strategies to align vaccination prioritisations.

Money is not everything: experimental evidence that payments do not increase willingness to be vaccinated against COVID-19.

Rapid, large-scale uptake of new vaccines against COVID-19 will be crucial to decrease infections and end the pandemic. In a recent article in this journal, Julian Savulescu argued in favour of monetary incentives to convince more people to be vaccinated once the vaccine becomes available. To evaluate the potential of his suggestion, we conducted an experiment investigating the impact of payments and the communication of individual and prosocial benefits of high vaccination rates on vaccination intentions. Our results revealed that none of these interventions or their combinations increased willingness to be vaccinated shortly after a vaccine becomes available. Consequently, decision makers should be cautious about introducing monetary incentives and instead focus on interventions that increase confidence in vaccine safety first, as this has shown to be an especially important factor regarding the demand for the new COVID-19 vaccines.

Willingness to bear economic costs of measures against SARS-CoV-2 in Germany.

BACKGROUND: The aim of this study was to assess the willingness of the general population in Germany to bear the economic costs of measures against the spread of SARS-CoV-2. METHODS: Repeated cross-sectional data were taken from three waves of a nationally representative survey of individuals aged 18 to 74 years (wave 8: 21-22 April 2020, N = 976; wave 16: 7-8 July 2020, N = 977; wave 38: 9-10 March 2021). The willingness to accept a reduction of annual household income in order to bear the economic costs of the measures against SARS-CoV-2 served as outcome measure. Two-part models were used including explanatory variables on sociodemographic and (subjectively assessed) potential health hazard caused by COVID-19. RESULTS: 65.5% (61.6%; 56.9%) of respondents in wave 8 (wave 16; wave 38) were willing to accept a reduction of income, with the likelihood for accepting a reduction of income being positively associated with higher affect (i.e. emotional reaction) and presumed severity regarding COVID-19 in all three waves. The mean maximum percentage of income participants were willing to give up was 3.3% (95% CI: 2.9 to 3.7%) in wave 8, 2.9% (95% CI: 2.5 to 3.3%) in wave 16 and 4.3% (95% CI: 3.6 to 5.0%) in wave 38, with presumed severity of COVID-19 being positively associated with this percentage in all three waves. CONCLUSIONS: The majority of respondents indicated willingness to sacrifice income in order to bear the costs of measures against the spread of SARS-CoV-2, with the potential health hazard caused by COVID-19 being consistently associated with this willingness. However, the proportion of individuals who were willing to give up income slightly decreased throughout the pandemic.

The four weeks before lockdown during the COVID-19 pandemic in Germany: a weekly serial cross-sectional survey on risk perceptions, knowledge, public trust and behaviour, 3 to 25 March 2020.

BackgroundDuring the COVID-19 pandemic, public perceptions and behaviours have had to adapt rapidly to new risk scenarios and radical behavioural restrictions.AimTo identify major drivers of acceptance of protective behaviours during the 4-week transition from virtually no COVID-19 cases to the nationwide lockdown in Germany (3-25 March 2020).MethodsA serial cross-sectional online survey was administered weekly to ca 1,000 unique individuals for four data collection rounds in March 2020 using non-probability quota samples, representative of the German adult population between 18 and 74 years in terms of age × sex and federal state (n = 3,910). Acceptance of restrictions was regressed on sociodemographic variables, time and psychological variables, e.g. trust, risk perceptions, self-efficacy. Extraction of homogenous clusters was based on knowledge and behaviour.ResultsAcceptance of restrictive policies increased with participants' age and employment in the healthcare sector; cognitive and particularly affective risk perceptions were further significant predictors. Acceptance increased over time, as trust in institutions became more relevant and trust in media became less relevant. The cluster analysis further indicated that having a higher education increased the gap between knowledge and behaviour. Trust in institutions was related to conversion of knowledge into action.ConclusionIdentifying relevant principles that increase acceptance will remain crucial to the development of strategies that help adjust behaviour to control the pandemic, possibly for years to come. Based on our findings, we provide operational recommendations for health authorities regarding data collection, health communication and outreach.

[Public trust in institutions in the first half of the Corona pandemic: findings from the COVID-19 Snapshot Monitoring (COSMO) project]. / Vertrauen der Bevölkerung in staatliche Institutionen im ersten Halbjahr der Coronapandemie: Erkenntnisse aus dem Projekt COVID-19 Snapshot Monitoring (COSMO).

BACKGROUND: In the coronavirus pandemic, two institutions play a central role in the evidence-based classification of events for politics and the population. The Robert Koch Institute (RKI) coordinates the fight against the pandemic, prepares well-founded recommendations for medical professionals, the media and the population, and advises politicians. The Federal Centre for Health Education (BZgA) informs the population and institutions. GOALS: The COVID-19 Snapshot Monitoring (COSMO) project monitors whether and how trust in institutions changes over the pandemic. Which population groups show trust and how this is related to attitudes, risk perception and behaviour are analysed. METHODS: Cross-sectional studies with approximately N = 1000 respondents per survey were conducted since March 2020 to investigate risk perception, behaviour, acceptance of measures and trust in institutions. RESULTS: Trust in the RKI and BZgA was generally high but declined over the course of the pandemic. Higher trust for both institutions was associated with higher age of respondents, higher education, higher risk perception and higher acceptance of measures. Behaviours such as physical distancing and handwashing were shown more frequently. Men and the chronically ill showed lower trust. DISCUSSION: The results show that trust should be further promoted. This could be achieved, among other things, by taking into account the population's perspective (e.g. through COSMO) in the development and justification of strategies and measures. Communication strategies and recommendations for action should aim to support and relieve people with high-risk perceptions.

Vicarious experiences of long COVID: A protection motivation theory analysis for vaccination intentions.

Context: Long COVID can appear as a severe late consequence (sequela) of a COVID-19 infection, leading to the inability to work or participate in social life for an unknown amount of time. To see friends or family struggling with long COVID might influence people's risk perceptions, vaccine efficacy expectations, and self-efficacy perceptions to prevent COVID-19 and its consequences. Methods: In an online survey in August 2022, n = 989 German-speaking participants indicated whether they knew someone who suffered from long COVID illness. Four dimensions of protection motivation theory (PMT) were assessed afterwards, as well as vaccination intentions. Results: Multiple mediation analysis with participants who knew vs. didn't know someone with long COVID (n = 767) showed that knowing someone with long COVID was associated with higher perceived affective and cognitive risk of long COVID-19 as well as higher perceived vaccine efficacy. Self-efficacy, i.e., the ease to protect oneself against long COVID, was lower in participants who knew long-COVID patients. Indirect positive effects for response efficacy and affective risk suggest that vicarious experience with long COVID is associated with increased intentions to get a COVID-19 vaccine. Conclusion: The protection from long COVID through vaccination are relevant aspects for individual decisions and health communication.

The moderating role of trust in pandemic-relevant institutions on the relation between pandemic fatigue and vaccination intentions.

This research helps to clarify the relation between pandemic fatigue (PF) and vaccination intentions (VI). Theoretically, two patterns seem plausible. First, as with any other health protective measure, PF might reduce the motivation to get vaccinated. Second, PF might increase the motivation to get vaccinated because vaccination reduces the number of (other) health protective measure needed. We tested these two opposing predictions and further explored the moderating role of trust in pandemic-relevant institutions on the link between PF and VI in two large-scale survey studies from Denmark and Germany (collected between 2020 and 2021; total N > 22,000). Data was analyzed using multiple regression models. Analyses reveal a negative link between PF and VI that is less pronounced for people high in trust. Results remain stable when accounting for covariates and quadratic trends. Thus, trust might buffer the negative relation between PF and VI.

Toward future triage regulations: Investigating preferred allocation principles of the German public.

BACKGROUND: When intensive care capacity is limited, triage may be required. Given that the German government started working on new triage legislation in 2022, the present study investigated the German public's preferences for intensive care allocation in two situations: ex-ante triage (where multiple patients compete for available resources) and ex-post triage (where admitting a new patient to intensive care means withdrawing treatment from another because ICU resources are depleted). METHOD: In an online experiment, N=994 participants were presented with four fictitious patients who differed in age and pre- and post-treatment chance of survival. In a series of pairwise comparisons, participants were asked to select one patient for treatment or to opt for random selection. Ex-ante and ex-post triage situations were varied between participants and preferred allocation strategies were inferred from their decisions. RESULTS: On average, participants prioritized better post-treatment prognosis ahead of younger age or treatment benefit. Many participants rejected random allocation (on the flip of a coin) or prioritization by worse pre-treatment prognosis. Preferences were similar for ex-ante and ex-post situations. DISCUSSION: Although there may be good reasons for deviating from laypeople's preference for utilitarian allocation, the results can help to design future triage policies and accompanying communication strategies.

Different Interventions for COVID-19 Primary and Booster Vaccination? Effects of Psychological Factors and Health Policies on Vaccine Uptake.

BACKGROUND: Mitigation of the COVID-19 pandemic requires continued uptake of SARS-CoV-2 vaccines. To increase vaccination intention and uptake, key determinants of primary and booster vaccination need to be understood and potential effects of vaccination policies examined. DESIGN: Using experimental data collected in Germany in February 2022 (N = 2701), this study investigated 1) predictors of primary and booster vaccination and 2) potential effects of policies combining vaccination mandates and monetary incentives. RESULTS: Compared with unvaccinated participants, those with primary vaccination were less complacent, more often understood the collective protection afforded by vaccination, and less often endorsed conspiracy-based misinformation. Compared with participants with primary vaccination, boosted individuals were even less complacent, exhibited fewer conspiracy-based beliefs, perceived fewer constraints by prioritizing vaccination over other things, and more often favored compliance with official vaccination recommendations. Support for and reactance about vaccination mandates depended on vaccination status rather than policy characteristics, regardless of mandate type or incentives (up to 500 EUR). While unvaccinated individuals rejected policy provisions and declined vaccination, boosted individuals indicated mid-level support for mandates and showed high vaccination intention. Among vaccinated individuals, higher incentives of up to 2000 EUR had a considerable positive effect on the willingness to get boosted, especially in the absence of a mandate. CONCLUSIONS: While mandates may be needed to increase primary vaccination, our results indicate that financial incentives could be an alternative to promote booster uptake. However, combining both measures for the same target group seems inadvisable in most cases. HIGHLIGHTS: Unvaccinated individuals and people with primary and booster vaccinations differ on psychological dimensions, calling for tailored immunization campaigns.Vaccination intentions depend on vaccination status rather than on mandatory or incentivizing policies.Incentives are unlikely to persuade unvaccinated individuals but may increase booster uptake.Positive effects of incentives decrease when vaccination is mandatory, advising against combination.

Filter Questions in Symptom Assessment Affect the Prevalence of (A)Symptomatic COVID-19 Cases.

BACKGROUND: It has been reported that a substantial number of COVID-19 infections are asymptomatic, with both symptomatic and asymptomatic infections contributing to transmission dynamics. Yet, the share of asymptomatic cases varies greatly across studies. One reason for this could be the measurement of symptoms in medical studies and surveys. DESIGN: In 2 experimental survey studies (total N > 3,000) with participants from Germany and the United Kingdom, respectively, we varied the inclusion of a filter question on whether participants who tested positive for COVID-19 had experienced symptoms prior to presenting a checklist of symptoms. We measured the reporting of asymptomatic (versus symptomatic) COVID-19 infections. RESULTS: The inclusion of a filter question increased the reporting of asymptomatic (versus symptomatic) COVID-19 infections. Particularly mild symptoms were underreported when using a filter question. CONCLUSIONS AND IMPLICATIONS: Filter questions affect the reporting of (a)symptomatic COVID-19 cases. To account for such differences in the estimation of population infection rates, future studies should transparently report the applied question format. HIGHLIGHTS: Both symptomatic and asymptomatic infections are important for COVID-19 transmission dynamics.In previous research, symptoms have been assessed either with or without a filter question prior to presenting a symptom list.We show that filter questions reduce the reporting of asymptomatic infections.Particularly mild symptoms are underreported when using a filter question.

The association between vaccination status identification and societal polarization.

Public discord between those vaccinated and those unvaccinated for COVID-19 has intensified globally. Theories of intergroup relations propose that identifying with one's social group plays a key role in the perceptions and behaviours that fuel intergroup conflict. We test whether identification with one's vaccination status is associated with current societal polarization. The study draws on panel data from samples of vaccinated (n = 3,267) and unvaccinated (n = 2,038) respondents in Germany and Austria that were collected in December 2021 and February, March and July 2022. The findings confirm that vaccination status identification (VSI) explains substantial variance in a range of polarizing attitudes and behaviours. VSI was also related to higher psychological reactance toward mandatory vaccination policies among the unvaccinated. Higher levels of VSI reduced the gap between intended and actual counterbehaviours over time by the unvaccinated. VSI appears to be an important measure for predicting behavioural responses to vaccination policies.