Understanding how people are coping during the COVID-19 Pandemic

13 Findings, 3 Adaptation Challenges + 1 Consequential Recommendation

Between March 24 and June 21, 2020 Decision Partners, along with our colleagues at Dunn & Associates, co-sponsored a recurring survey to better understand how people were coping in the initial months of the COVID-19 pandemic.

We believed we could help, in a small way, by doing what we do best – listening and learning – to understand people’s behaviour and decision making in this unprecedented time. Ultimately, we ran 9 surveys with people participating from across Canada, the US and other countries. Respondents’ responses and thoughtful comments provide an insightful, if anecdotal, view of their perceptions over time as the pandemic evolved. Many responded to multiple surveys, which gave us and these respondents an interesting perspective on how they were adapting from week to week to the challenging pandemic conditions.

This report summarizes our key findings and offers some insights to leaders from all sectors – government, public health, industry and businesses – about how their constituents, employees and customers are thinking about the pandemic and how they are adapting, coping, and making decisions about protecting their own health and safety, and that of their families, friends, and neighbours. We hope this insight will help leaders can better prepare, communicate and take action that will encourage safe and mindful behaviour, build confidence, and earn trust as we collectively go through the evolving experience of COVID-19. Highlights from each of the individual surveys are posted on the Decision Partners website.

Key Findings

1. When asked how they were coping in each survey, our respondents expressed a wide range of emotions that appeared to shift over the course of our surveys. The most frequent term use shifted from “anxious” to “tired” to “okay” and finally to “good”. 
2. Staying healthy was consistently the greatest concern for respondents, followed by understanding changing conditions and deciding what they are comfortable doing. 
3. Some worried about the long-term effects on mental health, for themselves and others, in particular if pandemic impacts continue for an extended time.
4. Respondents were actively engaged in staying informed about the pandemic, public health requirements, and what they needed to do to keep themselves and their families safe. 
5. Respondents appeared to have trust in and were paying close attention to the guidance of public health leaders in particular – at all levels. They wanted clarity but said they were not always getting it. In Canada, Dr. Tam, PHAC, CBC and the WHO were the most trusted sources of information on the pandemic. In the US, Dr. Fauci and the CDC were most trusted.
6. As the weeks went by, we saw respondents actively conducting their own personal risk assessments, weighing the risks, benefits and tradeoffs of various activities and behaviours.
7. Respondents seemed most comfortable with activities with fewer people, often outside, with more freedom of movement and personal control. Many were participating in such activities such as socializing in small groups, keeping their social bubbles pretty tight. 
8. Many were going to stores, but they are not entirely comfortable doing so. Some reported that others were not following public health recommendations about distancing or wearing masks. 
9. Our respondents were generally fairly cautious. They were least comfortable at activities with more people, less ability to distance and less freedom of movement. Generally, they said they would not participate in rallies, go to the gym, go to outdoor concerts, dine inside restaurants, or travel by air. 
10. Some expressed deep concerns about the potential consequences of lifting restrictions and opening the economy too soon and acting as if the risks are gone. They wanted assurance from leaders – public health, government and business – to inform their assessment of whether it was safe to go back to work and resume activities. They wanted assurance that effective hygiene procedures, diagnostic testing and physical distancing were in place. 
11. Respondents reported the pandemic had changed them in long-lasting ways, some positive: bringing them closer to their friends and family and helping them to reassess and reorder their priorities; and some negative: feeling more anxious, fearful, depressed, fatigued, and in some cases, particularly the US, being more distrustful and concerned about their political leadership.
12. In every survey, respondents were most grateful for family, health, friends, and home. 
13. Respondents’ advice to others: take care of yourself physically and mentally. Get exercise and fresh air; pace yourself and get help if you need it.

Our Perspective on What it All Means

As researchers who have been studying judgment, decision making and behaviour for 30 years, our overriding observation is that while people are pretty resilient, the prolonged uncertainty and changing dynamics around the pandemic have created an underlying stress, frustration and confusion that is wearing on people to varying degrees. 

Our concern is that pandemic fatigue may cause some people to simply give up and stop paying attention. We believe we are seeing evidence of that in some jurisdictions, with some cohorts, with dramatic consequences. For example, overcrowded beaches on the Canada Day and Memorial Day weekends and evidence that bars have become major risk vectors in some locations is resulting in an increase of COVID-19 in people under 40 in several places. As the pandemic continues, understanding what people are thinking about, how they are making decisions, and what is influencing their behaviour – in short, their mental models [1]– will become increasingly important.

Characteristics of the pandemic that have been particularly difficult for people to adapt to, include: 

• Pandemic-related issues are complex: Information about the virus, how it’s transmitted and how to protect oneself can be complicated. This is compounded by the patchwork of guidance and restrictions and that can vary significantly by geography: What is open, what is closed – and why? Are masks required or not? What kind of masks should be worn, when, where, how and by whom – and why? Who are the masks protecting – the wearer or others? The near total shutdowns in many areas imposed at the beginning of the pandemic, were painful, but the messages and the rationale was relatively simple and easy to understand. People understood what they had to do to help flatten the curve. Non-essential businesses were closed, and people understood they were to stay home as much as possible and practice safe hygiene. Now there are many more messages, many more messengers and significantly less clarity about the purpose, the rationale and whom to trust. 
• Uncertainty can be overwhelming: How infectious is the virus? How easily does it spread? How lethal is it? Who is most vulnerable? What activities and locations are the highest risk? What can I do to protect myself and others? How effective are masks? How effective are treatments? When will we have a vaccine? When will this end? People have a lot of questions, but there aren’t always definite answers. There is often uncertainty and differences of opinion among experts and some people don’t understand the inherent uncertainty in the scientific process. This uncertainty is compounded by a lot of non-science-based misinformation, much of it delivered through social media. Trust and confidence in science and scientists is at risk. Clear, consistent, science-based messages delivered by trusted and credible sources are needed to rise above the noise and confusion.
• Everything keeps changing: Whether due to changing understanding, or changing conditions on the ground, the circumstances of the pandemic keep changing. Guidance and restrictions are imposed, lifted and re-imposed; Masks are not effective then very effective; Therapies are effective, then dangerous, then maybe effective again, or not. To some, if the previous guidance was “wrong”, then why should the new guidance be trusted? Public health authorities are being questioned and their expertise and their integrity are being challenged by some. But adapting to new information and understanding is a central part of the scientific discovery process. Communicating what scientists are learning, why it is important, how it informs policies and decision making, and what is still being studied is critical now and going forward.

These difficulties point to a simple conclusion: 

People need clear, consistent, guidance about managing risk, communicated effectively and in a way that is relevant to them in order to make well-informed decisions.

In addition to mask wearing and understanding and following current public health guidance, a key decision many people are facing now is whether it is safe to send children back to school. The uncertainty, new research and changing understanding about the degree to which younger people are vulnerable to the impacts of infection and the degree to which they can transmit the virus to others has key implications for decision making about children returning to school and daycare and youth returning to college and university. 

Parents, teachers, school boards, administrators and other policy makers need a full understanding about what is and is not known at this time about the virus as it relates to children and young adults, so they can make well-informed decisions and take appropriate action. Key to this will be having scientists and public health experts communicate not just what is known, but what is not known and what is uncertain.

Our recommendation

Proven, science-based risk communications fundamentals should be followed to improve engagement and communications, and to help people make well-informed decisions and take appropriate actions.

Social and behavioural science provide critical insight into where people are today in their thinking, their understanding of the virus, the pandemic and their priorities. Such approaches can and should be used to identify details of people’s mental models, what they know, what they don’t know, what they misunderstand, what questions they have, and what sources that they trust. Mental models influence people’s judgment, decision-making and behaviour. Insight into people’s mental models enables leaders to appropriately engage their employees, customers and constituents by developing communications that are: 

• Clear, concise and simple – so that people understand what is important.
• Compelling and comprehensive – so that people understand why it is relevant to them. In particular, it needs to explain the rationale for changes in restrictions and recommendations and, where appropriate, how the scientific process works and why the experts are changing their advice (as they did on wearing masks). When such detail and rationale are not provided in a way that is meaningful to people, there will always be others willing to fill the void.
• Consistent – across official channels including political and public health leaders. Conflicting messages tend to lead to polarization of issues. People then choose the messages and messengers they trust, which can lead to distrust of officials and the rise of alternate “experts”.
• Focused on critical populations – and the behaviour and actions they need to take to keep themselves and others safe. This includes populations that are most vulnerable or dependent, such as seniors, on one end of the spectrum, and younger people at the other end. Messages need to be focused accordingly.
• Pretested – with the intended populations to ensure that messages are understood, compelling, relevant and enable well-informed decision making. 
• Monitored – in an ongoing fashion to assess and adapt to changing circumstances as the pandemic evolves and new research and information becomes available. Messages must be kept relevant and timely if people are expected to stay engaged.

Given the current infodemic as defined by the WHO[1], effective communication is more challenging and all the more necessary. In particular, we are concerned that effective communication will continue to be an issue as a COVID-19 vaccine or vaccines become available, unless reputable social and behavioural science is used to provide the insight needed to inform risk policy decision making and communications about the vaccine and its efficacy. 

In the absence of effective communication, people will make their own decisions about what to do, sometimes to the detriment of greater public health objectives intended for the greater public good. 

Thank You

We want to thank all those who participated in our survey and shared your thoughts. We hope the insights from this Summary Report will help leaders better prepare, communicate and take action that will encourage safe and mindful behaviour, build confidence, and earn trust as we collectively go through the evolving experience of COVID-19.

Sarah Thorne, President, Decision Partners

Dan Kovacs, Senior Scientist, Decision Partners

Denise Carpenter, Senior Consultant, Decision Partners

Katherine Sousa, Research Associate, Decision Partners

Michael Dunn, President, Dunn & Associates Communications and Public Affairs

Appendix 1 – About Decision Partners 

Decision Partners provides comprehensive solutions based on advanced behavioural decision research. We use insight to precisely focus strategies, policies and communications on key influences on people’s judgment, decision making and behaviour. Our methods are based on current understanding in cognitive psychology, decision science, risk management, risk perception and risk communication. Stakeholder engagement is a critical component of our approach. 

Our approach, Mental Modeling Insight? (MMI?)[3], is a proven, evidence-based and science-informed management process for developing policies, strategies, interventions and communications that deliver measurable behavioural outcomes. 

For three decades, Decision Partners has been leading development and implementation of research-based initiatives at public and private organizations across a broad range of stakeholder engagement challenges, including climate change, energy, health care, public health, occupational health and safety, emergency preparedness, organizational transformation, sustainability and operational resilience. 

For more information about Decision Partners or about our COVID-19 Coping Survey, please see our website: www.decisionpartners.co or contact us at dprc[at]decisionpartners.co or 1-519-344-3232.

Appendix 2 – About Dunn & Associates

Dunn & Associates are strategic business advisors and communicators who help organizations understand, engage and communicate with their stakeholders through evidence-informed policy, strategy and communication decisions. As a result, our clients go beyond merely “building awareness” to achieving priority behavioural outcomes for a better, more-sustainable world.

Based in Halifax on Canada’s East Coast, Dunn & Associates brings together local, regional and international networks of seasoned associates - including our scientist, researcher, analyst and management consultant colleagues at Decision Partners - to deliver outstanding results for clients wherever their interests are located. We are proud to be Certified Mental Modelling Insight? practitioners.

Since 2005, Dunn & Associates has been supporting the missions and strategic priorities of public and private organizations through our expertise in: stakeholder research and engagement; behavioural communications (media relations, corporate communications and public affairs); issue preparedness, management and response; strategic planning and facilitation; communications planning, process mapping and improvement; and communicator/media training and coaching.

For more information about Dunn & Associates visit www.dunnassociates.ca or contact us at michael.dunn[at]dunnassociates.ca or 1-902-422-6014.

Appendix 3 – Coping Survey Respondent Demographics

Our survey respondents were recruited via a convenience sample, reaching out to our network of colleagues and friends and encouraging them to forward the surveys to others. We received more than 2,270 substantive individual responses across all surveys, mostly from Canada (primarily Ontario, Nova Scotia and Alberta) and the US (spread across a number of states with Pennsylvania being the most represented). The median age range of our respondents was 55-64 and two thirds of our respondents were women. About a quarter of respondents had children under 18 at home and about 40% had at least one person over age 65 in the home. 

[1] Mental models are the tacit webs of belief that guide learning, interpretation of information, and complex psychological processes of judgment, decision making and behaviour. See: Morgan, M.G., B. Fischhoff, A. Bostrom, and C.J. Atman. (2002). “Risk Communication: A Mental Models Approach”; and Wood, M. D., Thorne, S., Kovacs, D., Butte, G., & Linkov, I. (2017). “Mental Modeling Approach: Risk Management Application Case Studies.”

[2] “An overabundance of information—some accurate and some not—that makes it harder for people to find trustworthy sources and reliable guidance when needed” – The Lancet, Vol 396, Issue 10247, P291, August 1, 2020 

[3] Based on foundational research by scientists at Carnegie Mellon University, led by Baruch Fischhoff, PhD, who is also Decision Partners’ Chief Scientist. See: Morgan, M.G., B. Fischhoff, A. Bostrom, and C.J. Atman. (2002). “Risk Communication: A Mental Models Approach.” New York: Cambridge University Press; and Baruch Fischhoff, Noel Brewer and Julie S. Downs (editors) (2011) “Communicating Risks and Benefits: An Evidence Based User’s Guide” Department of Health and Human Service, U.S. Food and Drug Administration.