What drives resistance to public health measures in Canada’s COVID-19 pandemic? An online survey of Canadians’ knowledge, attitudes, and practices

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Jack G Underschultz
Paul Barber
Daniel Richard
Tracey Hillier



Background: The ongoing COVID-19 pandemic has spread across 188 countries and claimed over 300,000 lives so far. Despite strong public health messaging and strict community restrictions in Canada, misconceptions and high-risk behaviours such as mass public gatherings have contributed to its spread across the country. Local data on the knowledge, attitudes, and practices from high-case areas could inform public health messaging during the current unprecedented pandemic.

Study Objective: To collate and describe the knowledge, attitudes, and practices of highly affected Canadian communities related to the COVID-19 pandemic and to evaluate factors associated with risky behaviours in order to inform public health policies and communication.

Methods and Study Design: Information on COVID-19 knowledge, attitudes, and practices was collected via online convenience sampling from 1,593 Canadians between 6 to 26 April, 2020. The high outbreak provinces of Alberta and Ontario were targeted.

Findings: While knowledge of COVID-19 transmission and prevention was high (mean knowledge score of 10.5/12 (88%)), a significant minority of respondents (32%) expressed at least one attitude resistant to public messaging that could hamper containment efforts: visiting crowded places other than grocery stores or pharmacies, close encounters with non-household members, and intention not to isolate if having mild flu symptoms, or known COVID-19 exposure. Factors associated with these risky behaviours included low COVID-19 knowledge (OR 1.2 (95% CI 1.1-1.3), p=0.0057), feeling not worried (OR 2.9 (95% CI 2.2-3.9), p<0.001), and feeling uninformed about the pandemic (OR 1.6 (95% CI 1.1-2.3), p=0.030). Respondents reported high acceptance of a potential vaccine (93%) and endorsed a wide-spread vaccination strategy (81%).

Interpretation: Low levels of knowledge and worry regarding COVID-19 may be key contributors to resistance against public health messaging. A potential vaccine, if made available to the general public, would likely be widely accepted.