Non-adherence to COVID-19 containment behavioursresults from an all-Ireland telephone survey

Why do some people follow public health advice to the letter, while others just do not? It’s not because they are good or bad people. Often, it comes down to how we perceive a threat and what we believe we can do about it. That’s the heart of Protection Motivation Theory, or PMT. It tells us that we run two quick mental checklists. One checklist asks, how bad is this thing and how likely am I to be affected? The other checklist asks, can I actually do the protective action, will it work, and what will it cost me? Layer on top what we think the people around us expect—social norms—and you've got a compact way to predict protective behavior in a pandemic. Martin Dempster and Paula O’Connell tested this framework during the first COVID summer across the whole island of Ireland—two jurisdictions, Northern Ireland and the Republic of Ireland, with different governments and sometimes different guidance, but one epidemiological island. They set a simple, sharp target: to figure out who wasn't washing their hands or keeping their distance, and which beliefs and circumstances best explained it. The design was straightforward and, for that moment, ambitious. An eight-week rolling telephone survey, from mid-June to early August 2020, reached a nationally weighted sample of three thousand eleven adults across both jurisdictions. Every week brought a fresh cross-section. Participants reported how often, in the prior two weeks, they had washed their hands for at least twenty seconds and stayed at least two meters from others. "Often" or "sometimes" counted as adherent; "rarely" or "not at all" meant non-adherent. Then the team ran separate logistic regressions—one for handwashing and another for distancing—to see what predicted falling into that non-adherent group. The topline? Non-adherence was rare for handwashing, about two point four percent, and more common for distancing, about six point four percent. Take a breath and hold those anchors; we'll keep coming back to them. Let's start at the sink. The people who said they weren't washing their hands reliably looked different from the rest. They were much more likely to be men—about five times more likely, in odds terms. They were lonelier; that loneliness was tied to roughly one point eight six times the odds of not washing. And they were more likely to see handwashing as costly—time-consuming, inconvenient—which carried the biggest punch after gender, around three point four times the odds of skipping it. On the coping side of PMT, two beliefs protected people: feeling confident that you can do it, and sensing that the people around you expect it. Higher self-efficacy cut the odds roughly in half, and stronger perceived social norms pulled in the same direction. Notice what's missing here. Fear of COVID-19 itself didn't do much to drive handwashing in this sample. This is a pattern we've seen in other health behaviors: when a behavior is simple and cheap, confidence and habit crowd out the sense of threat. Now walk with me into the social space between people, because social distancing told a different story. Being younger nudged people toward non-adherence; each additional year of age lowered the odds by a few percent, about zero point ninety-seven per year. Men again were more likely to be non-adherent, though the effect was much smaller than for handwashing. Healthcare workers—who were in the thick of it—also reported more lapses in distancing, nearly double the odds compared to others. And people not living with anyone under eighteen were more likely to drift from the two-meter rule; living with kids looked slightly protective, around zero point seventy-five in the odds ratio. Socioeconomic status mattered too: those in lower social classes showed higher non-adherence. Different from the sink, right? You're seeing age, role, and context start to loom large. Now plug PMT back in for distancing, and the pieces click. Here, threat mattered. Lower fear of COVID-19 was linked to more non-adherence—again in odds terms, around zero point eighty per unit increase in fear, meaning more fear leads to less non-adherence. Coping beliefs still counted, but they spread out across multiple levers. If you didn't think distancing worked, you were less likely to do it; higher response efficacy brought the odds down to about zero point fifty-seven. If you weren't confident you could keep your distance in everyday life, the odds of non-adherence rose; more self-efficacy pushed them down to about zero point sixty-seven. And if you felt distancing was costly—socially awkward, impractical—the odds ticked up, with a smaller effect size than handwashing, roughly one point thirty-one. Perceived norms also mattered. Weaker norms around distancing went hand in hand with not doing it, even when you accounted for those other beliefs. Mood colored the distancing picture too. People reporting lower mood—think more depressive symptoms—were more likely to skip distancing. That doesn't mean sadness causes contagion. It suggests that when you're low, adding another rule to an already thinly stretched day can be a bridge too far. Pair that with the healthcare worker effect, and you can see how feasibility and fatigue—what PMT would call response costs—become real constraints. Stepping back, you can hear two distinct chords. Handwashing non-adherence clustered around coping appraisals and loneliness. It’s less about how scary the virus feels and more about "can I do this, will it be a hassle, do my people do this?" Social distancing non-adherence braided threat appraisals with coping and context. Younger age, lower social class, being a healthcare worker, and lower mood all point to environments where distancing is harder or less compelling, and where the belief that it works or is expected has more work to do. A quick word on the island split, because that's one of the clever parts of this design. Despite the two governments and at times different messaging, Dempster and O’Connell didn't detect meaningful differences between Northern Ireland and the Republic on either behavior. No jurisdictional gap for handwashing. None for distancing. In other words, during that summer, who you were and how you thought about the behavior mattered more than which side of the border you lived on. There are a few guardrails on how far to take this. The survey was self-report, so social desirability could inflate adherence. It was cross-sectional, a series of snapshots, so you can't claim causation. The data landed during a moment of easing restrictions, which could have buoyed compliance. And for handwashing in particular, the number of non-adherers was small—seventy-one people—so some estimates are inevitably wobbly. That said, for a rapid, all-Ireland barometer, the study did a lot right: fresh samples each week, national weighting, a clean split between two core behaviors, and, remarkably, no missing data. So what do we do with this? First, stop treating "adherence" like a single personality trait. Washing your hands and keeping your distance may both be pandemic behaviors, but they live in different psychological neighborhoods. For handwashing, the heavy hitters are male gender, perceived hassle, low confidence, and loneliness. You don't need to scare people about the virus to move that needle. You need to make it easy, make it automatic, and make it feel expected. The fact that self-efficacy sliced the odds of non-adherence almost in half tells you something: a good sign by the sink and a nudge about how to do a proper twenty seconds probably go further than another alarming statistic. For distancing, you need a broader toolkit. Younger adults and men were more likely to slip, but it isn’t just demographics. It's whether people believe distance works, whether they think they can actually keep two meters in the places they live and work, and whether the norms around them support it. The finding that healthcare workers had nearly double the odds of non-adherence is a reality check; in hospitals and care homes, six feet isn't always feasible. Response cost isn't an attitude there—it’s the job. That's where organizational changes matter more than messaging. And where messaging is the lever, it has to raise perceived effectiveness and social expectation without dragging mood into the basement. You might be wondering about fear. It didn't affect handwashing, but it did matter for distancing. That doesn't license fear-mongering. It points to calibrated threat—clear information about risk that makes distancing feel purposeful rather than performative. When people think it works and feel others expect it, they do it more. PMT, along with norms, provides that map. If you're designing a campaign for the next respiratory outbreak, this is the practical translation. For handwashing: talk to men directly, reduce the hassle, and boost confidence with specific, doable prompts. For distancing: target younger crowds where social life is dense, explain why distancing helps, model it in the settings that feel impossible, and enlist peers and workplaces to set the norm. The island of Ireland offers one more lesson here. Policy headlines can diverge, but on the ground, people's beliefs and contexts do the heavy lifting. That's where precision matters—behavior by behavior, belief by belief. And that last point is the quiet strength of Dempster and O’Connell's work. They didn't reinvent behavioral science. They took a tight, tested theory, stitched in social norms, and ran it in real time across a whole population. Two numbers—two point four percent for handwashing non-adherence, and six point four percent for distancing—set the scene. The rest was about who sits in those small slices and why. If you remember nothing else, remember this: when you want people to protect themselves and others, make the action feel doable, effective, and expected. That trio travels further than fear alone, and it points you to the right levers, even—maybe especially—when the rules are the same on both sides of a border.