Motivations and Limits for COVID-19 Policy Compliance in Germany and Switzerland

Document Type : Original Article

Authors

1 Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany

2 Institute for Biomedical Ethics, University of Basel, Basel, Switzerland

Abstract

Background 
In contrast to neighboring countries, German and Swiss authorities refrained from general curfews during the first pandemic wave in spring 2020, calling for solidarity and personal responsibility instead. Using a qualitative methodology, this study aims to explore why people in Germany and Switzerland were motivated to comply with policy measures during the first wave of the coronavirus disease 2019 (COVID-19) pandemic, and what factors hindered or limited their motivation. While quantitative surveys can measure the level of compliance, or broadly ask what motives people had for compliance, we here strive to explain why and how these motives lead to compliance.
 
Methods 
This publication has been made possible by the joint work of the members of the “Solidarity in times of pandemics” (SolPan) research commons. Seventy-seven semi- structured qualitative interviews were conducted with members of the general public in Germany (n = 46) and the German-speaking part of Switzerland (n = 31) in April 2020. Interviews were transcribed and analyzed following a grounded theory approach.
 
Results 
Three themes were identified that summarize factors contributing to compliant or noncompliant behavior. (1) Social cohesion was, on the one hand, an important motivator for compliance, but at the same time related to conflicting needs, illustrating the limits of compliance. (2) Consequences were considered on both the individual level (eg, consequences of individual infection) and societal level (eg, the societal and economic consequences of restrictions). (3) While for some participants following the rules was perceived as a matter of principle, others stressed the importance of making their own risk assessment, which was often associated with with a need for evidence on the effectiveness and reasons behind measures.
 
Conclusion 
A variety of motives contribute to COVID-19 related compliance. Authorities should seek to address these multi-faceted aspects to support motivation for compliance in a large proportion of the population.

Keywords

Main Subjects

References

  1. Merkel A. Ansprache der Kanzlerin: “Dies ist eine historische Aufgabe - und sie ist nur gemeinsam zu bewältigen.” [German]. https://www.bundeskanzlerin.de/bkin-de/mediathek/videos/ansprache-der-kanzlerin-1732108.  Updated March 18, 2020. Accessed February 19, 2021.
  2. Steinmeier FW. Videobotschaft zur Corona-Epidemie: “Nur der Verzicht verhindert, dass wir dauerhaft verlieren, was wir lieben.” [German]. https://www.bundespraesident.de/SharedDocs/Reden/DE/Frank-Walter-Steinmeier/Reden/2020/03/200326-Videobotschaft-Coronahelden.html.  Updated March 26, 2020. Accessed February 19, 2021.
  3. Bühler S, Friedli D. Coronavirus: Alain Berset erklärt die Massnahmen des Bundesrates. Neue Zürcher Zeitung; 2020. [German]. https://nzzas.nzz.ch/schweiz/coronavirus-alain-berset-erklaert-die-massnahmen-des-bundesrates-ld.1546535.  Accessed October 27, 2020.
  4. Bundesregierung. Maskenpflicht gilt ab sofort. [German]. https://www.bundesregierung.de/breg-de/themen/coronavirus/maskenpflicht-in-deutschland-1747318.  Updated April 29, 2020. Accessed November 4, 2020.
  5. The Federal Council. Coronavirus: Masks Compulsory on Public Transport; Quarantine for Travellers from High-Risk Regions; Lifting of Certain Entry Restrictions from 20 July. https://www.admin.ch/gov/en/start/documentation/media-releases.msg-id-79711.html.  Updated July 22, 2020. Accessed November 4, 2020.
  6. Sager F, Mavrot C. Switzerland’s COVID-19 policy response: consociational crisis management and neo-corporatist reopening. Eur Policy Anal. 2020;6(2):293-304. doi:10.1002/epa2.1094
  7. Naumann E, Möhring K, Reifenscheid M, et al. COVID-19 policies in Germany and their social, political, and psychological consequences. Eur Policy Anal. 2020;6(2):191-202. doi:10.1002/epa2.1091
  8. The Federal Council. Federal Council to Gradually Ease Measures Against the New Coronavirus. https://www.admin.ch/gov/en/start/documentation/media-releases.msg-id-78818.html.  Updated April 16, 2020. Accessed November 10, 2020.
  9. The Federal Council. Coronavirus: Federal Council to Ease Further Measures from 11 May. https://www.admin.ch/gov/en/start/documentation/media-releases.msg-id-78948.html.  Updated April 29, 2020. Accessed November 10, 2020.
  10. Froming WJ, Carver CS. Divergent influences of private and public self-consciousness in a compliance paradigm. J Res Pers. 1981;15(2):159-171. doi:10.1016/0092-6566(81)90015-5
  11. Prainsack B, Buyx A. Solidarity in Biomedicine and Beyond. Cambridge: Cambridge University Press; 2017.
  12. Prainsack B, Buyx A. Solidarity: Reflections on an Emerging Concept in Bioethics. London: Nuffield Council on Bioethics; 2011.
  13. Prainsack B, Buyx A. Solidarity in contemporary bioethics-towards a new approach. Bioethics. 2012;26(7):343-350. doi:10.1111/j.1467-8519.2012.01987.x
  14. Al-Hasan A, Yim D, Khuntia J. Citizens’ adherence to COVID-19 mitigation recommendations by the government: a 3-country comparative evaluation using web-based cross-sectional survey data. J Med Internet Res. 2020;22(8):e20634. doi:10.2196/20634
  15. Bargain O, Aminjonov U. Trust and Compliance to Public Health Policies in Times of COVID-19. Bonn, Germany: IZA Institute of Labor Economics; 2020.
  16. Wong CML, Jensen O. The paradox of trust: perceived risk and public compliance during the COVID-19 pandemic in Singapore. J Risk Res. 2020;23(7-8):1021-1030. doi:10.1080/13669877.2020.1756386
  17. Brodeur A, Grigoryeva I, Kattan L. Stay-at-Home Orders, Social Distancing and Trust. Bonn, Germany: IZA Institute of Labor Economics; 2020.
  18. Wu C. Social capital and COVID-19: a multidimensional and multilevel approach. Chin Sociol Rev. 2021;53(1):27-54. doi:10.1080/21620555.2020.1814139
  19. Nivette A, Ribeaud D, Murray A, et al. Non-compliance with COVID-19-related public health measures among young adults in Switzerland: Insights from a longitudinal cohort study. Soc Sci Med. 2021;268:113370. doi:10.1016/j.socscimed.2020.113370
  20. Meier K, Glatz T, Guijt MC, et al. Public perspectives on protective measures during the COVID-19 pandemic in the Netherlands, Germany and Italy: a survey study. PLoS One. 2020;15(8):e0236917. doi:10.1371/journal.pone.0236917
  21. Guzek D, Skolmowska D, Głąbska D. Analysis of gender-dependent personal protective behaviors in a national sample: polish adolescents’ COVID-19 experience (PLACE-19) study. Int J Environ Res Public Health. 2020;17(16):5770. doi:10.3390/ijerph17165770
  22. Chong YY, Chien WT, Cheng HY, et al. The role of illness perceptions, coping, and self-efficacy on adherence to precautionary measures for COVID-19. Int J Environ Res Public Health. 2020;17(18). doi:10.3390/ijerph17186540
  23. Gustavsson J, Beckman L. Compliance to recommendations and mental health consequences among elderly in Sweden during the initial phase of the COVID-19 pandemic-a cross sectional online survey. Int J Environ Res Public Health. 2020;17(15):5380. doi:10.3390/ijerph17155380
  24. Pollak Y, Dayan H, Shoham R, Berger I. Predictors of non-adherence to public health instructions during the COVID-19 pandemic. Psychiatry Clin Neurosci. 2020;74(11):602-604. doi:10.1111/pcn.13122
  25. Tabernero C, Castillo-Mayén R, Luque B, Cuadrado E. Social values, self- and collective efficacy explaining behaviours in coping with Covid-19: self-interested consumption and physical distancing in the first 10 days of confinement in Spain. PLoS One. 2020;15(9):e0238682. doi:10.1371/journal.pone.0238682
  26. Hamidi S, Zandiatashbar A. Compact development and adherence to stay-at-home order during the COVID-19 pandemic: a longitudinal investigation in the United States. Landsc Urban Plan. 2021;205:103952. doi:10.1016/j.landurbplan.2020.103952
  27. Dzisi EKJ, Dei OA. Adherence to social distancing and wearing of masks within public transportation during the COVID 19 pandemic. Transp Res Interdiscip Perspect. 2020;7:100191. doi:10.1016/j.trip.2020.100191
  28. Ölcer S, Yilmaz-Aslan Y, Brzoska P. Lay perspectives on social distancing and other official recommendations and regulations in the time of COVID-19: a qualitative study of social media posts. BMC Public Health. 2020;20(1):963. doi:10.1186/s12889-020-09079-5
  29. Lim S, Nakazato H. The emergence of risk communication networks and the development of citizen health-related behaviors during the COVID-19 pandemic: social selection and contagion processes. Int J Environ Res Public Health. 2020;17(11):4148. doi:10.3390/ijerph17114148
  30. Wolf LJ, Haddock G, Manstead ASR, Maio GR. The importance of (shared) human values for containing the COVID-19 pandemic. Br J Soc Psychol. 2020;59(3):618-627. doi:10.1111/bjso.12401
  31. Williams SN, Armitage CJ, Tampe T, Dienes K. Public perceptions and experiences of social distancing and social isolation during the COVID-19 pandemic: a UK-based focus group study. BMJ Open. 2020; 10(7):e039334. doi:10.1136/bmjopen-2020-039334
  32. Egorov G, Enikolopov R, Makarin A, Petrova M. Divided We Stay Home: Social Distancing and Ethnic Diversity. Cambridge, MA: National Bureau of Economic Research; 2020. doi:10.3386/w27277
  33. de la Vega R, Ruíz-Barquín R, Boros S, Szabo A. Could attitudes toward COVID-19 in Spain render men more vulnerable than women? Glob Public Health. 2020;15(9):1278-1291. doi:10.1080/17441692.2020.1791212
  34. Solomou I, Constantinidou F. Prevalence and predictors of anxiety and depression symptoms during the COVID-19 pandemic and compliance with precautionary measures: age and sex matter. Int J Environ Res Public Health. 2020;17(14):4924. doi:10.3390/ijerph17144924
  35. Steens A, Freiesleben de Blasio B, Veneti L, et al. Poor self-reported adherence to COVID-19-related quarantine/isolation requests, Norway, April to July 2020. Euro Surveill. 2020;25(37). doi:10.2807/1560-7917.es.2020.25.37.2001607
  36. Zhao SZ, Wong JYH, Wu Y, Choi EPH, Wang MP, Lam TH. Social distancing compliance under COVID-19 pandemic and mental health impacts: a population-based study. Int J Environ Res Public Health. 2020; 17(18):6692. doi:10.3390/ijerph17186692
  37. Deopa N, Forunato P. Coronagraben. Culture and social distancing in times of COVID-19. SSRN Journal. 2020. doi:10.2139/ssrn.3635287
  38. Tamamoto KA, Rousslang ND, Ahn HJ, Better HE, Hong RA. public compliance with face mask use in Honolulu and regional variation. Hawaii J Health Soc Welf. 2020;79(9):268-271.
  39. Bäuerle A, Teufel M, Musche V, et al. Increased generalized anxiety, depression and distress during the COVID-19 pandemic: a cross-sectional study in Germany. J Public Health (Oxf). 2020;42(4):672-678. doi:10.1093/pubmed/fdaa106
  40. Teufel M, Schweda A, Dörrie N, et al. Not all world leaders use Twitter in response to the COVID-19 pandemic: impact of the way of Angela Merkel on psychological distress, behaviour and risk perception. J Public Health (Oxf). 2020;42(3):644-646. doi:10.1093/pubmed/fdaa060
  41. sotomo. Die Schweiz und die Corona-Krise: Monitoring der Bevölkerung [German]. Commissioned by the Swiss Broadcasting Corporation SRG SSR. https://sotomo.ch/site/wp-content/uploads/2020/12/SRG_Bevoelkerungsmonitoring_Coronakrise_20200324.pdf.  Updated March 24, 2020. Accessed February 19, 2021.
  42. sotomo. Die Schweiz und die Corona-Krise: Monitoring der Bevölkerung [German]. Commissioned by the Swiss Broadcasting Corporation SRG SSR. https://sotomo.ch/site/wp-content/uploads/2020/12/SRG_sotomo_Monitoring_Coronakrise_W2_web.pdf.  Updated April 7, 2020. Accessed February 19, 2021.
  43. sotomo. Die Schweiz und die Corona-Krise: Monitoring der Bevölkerung [German]. Commissioned by the Swiss Broadcasting Corporation SRG SSR. https://sotomo.ch/site/wp-content/uploads/2020/12/SRG_sotomo_Monitoring_Coronakrise_W3_web.pdf.  Updated May 7, 2020. Accessed February 19, 2021.
  44. SolPan consortium. Solidarity in times of a pandemic: What do people do, and why? https://digigov.univie.ac.at/solidarity-in-times-of-a-pandemic-solpan/.  Accessed March 3, 2021.
  45. Zimmermann BM, Fiske A, Prainsack B, Hangel N, McLennan S, Buyx A. Early perceptions of COVID-19 contact tracing apps in German-speaking countries: comparative mixed methods study. J Med Internet Res. 2021;23(2):e25525. doi:10.2196/25525
  46. Consortium, SolPan, Interview Guide ‘Solidarity in Times of a Pandemic.’ https://ssrn.com/abstract=3824361.  Published April 11, 2021.
  47. Guest G, Bunce A, Johnson L. How many interviews are enough? an experiment with data saturation and variability. Field Methods. 2006; 18(1):59-82. doi:10.1177/1525822x05279903
  48. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-357. doi:10.1093/intqhc/mzm042
  49. Charmaz K. Constructing Grounded Theory. SAGE; 2014.
  50. SolPan consortium. Codebook ‘Solidarity in Times of a Pandemic.’ SSRN Journal. 2021.
  51. Low J. A pragmatic definition of the concept of theoretical saturation. Sociol Focus. 2019;52(2):131-139. doi:10.1080/00380237.2018.1544514
  52. Forster C, Rhyn L. Coronavirus: Bundesrat schränkt das öffentliche Leben stark ein. Neue Zürcher Zeitung; 2020. [German]. https://www.nzz.ch/schweiz/coronavirus-bundesrat-schraenkt-das-oeffentliche-leben-stark-ein-ld.1546356?reduced=true.  Accessed October 27, 2020.
  53. Nitschke JP, Forbes PAG, Ali N, et al. Resilience during uncertainty? greater social connectedness during COVID-19 lockdown is associated with reduced distress and fatigue. Br J Health Psychol. 2020. doi:10.1111/bjhp.12485
  54. Kachanoff FJ, Bigman YE, Kapsaskis K, Gray K. Measuring realistic and symbolic threats of COVID-19 and their unique impacts on well-being and adherence to public health behaviors. Soc Psychol Personal Sci. 2020:1948550620931634. doi:10.1177/1948550620931634
  55. Ayalon L, Chasteen A, Diehl M, et al. Aging in times of the COVID-19 pandemic: avoiding ageism and fostering intergenerational solidarity. J Gerontol B Psychol Sci Soc Sci. 2021;76(2):e49-e52. doi:10.1093/geronb/gbaa051
  56. Fraser S, Lagacé M, Bongué B, et al. Ageism and COVID-19: what does our society’s response say about us? Age Ageing. 2020;49(5):692-695. doi:10.1093/ageing/afaa097
  57. Prainsack B. Solidarity in times of pandemics. Democr Theory. 2020; 7(2):124-133. doi:10.3167/dt.2020.070215
  58. Deutscher Ethikrat. Solidarity and Responsibility During the Coronavirus Crisis: Ad-hoc Recommendation. https://www.ethikrat.org/fileadmin/Publikationen/Ad-hoc-Empfehlungen/englisch/recommendation-coronavirus-crisis.pdf.  Updated March 27, 2020. Accessed February 19, 2021.
  59. Schweizer Radio und Fernsehen (SRF). Das Coronavirus und wir - Eigenverantwortung – ein letztes bisschen Freiheit. [German]. https://www.srf.ch/news/schweiz/das-coronavirus-und-wir-eigenverantwortung-ein-letztes-bisschen-freiheit.  Updated March 27, 2020. Accessed November 2, 2020.
  60. Leopoldina. Coronavirus-Pandemie - Die Krise nachhaltig überwinden: Dritte Ad-hoc-Stellungnahme. [German]. https://www.leopoldina.org/uploads/tx_leopublication/2020_04_13_Coronavirus-Pandemie-Die_Krise_nachhaltig_%C3%BCberwinden_final.pdf.  Updated April 13, 2020. Accessed February 19, 2021.
  61. Bandura A. Self-efficacy. In: Weiner IB, Corsini RJ, eds. The Corsini Encyclopedia of Psychology. Hoboken, NJ: Wiley; 2010.
  62. Desson Z, Lambertz L, Peters JW, Falkenbach M, Kauer L. Europe’s Covid-19 outliers: German, Austrian and Swiss policy responses during the early stages of the 2020 pandemic. Health Policy Technol. 2020; 9(4):405-418. doi:10.1016/j.hlpt.2020.09.003
  63. Kirch W. Prevention paradox. In: Kirch W, ed. Encyclopedia of Public Health. Dordrecht: Springer-Verlag Berlin Heidelberg; 2008:138.
  64. Neuburger L, Egger R. Travel risk perception and travel behaviour during the COVID-19 pandemic 2020: a case study of the DACH region. Curr Issues Tour. 2020:1-14. doi:10.1080/13683500.2020.1803807
  65. Wagenaar WA, Sagaria SD. Misperception of exponential growth. Percept Psychophys. 1975;18(6):416-422. doi:10.3758/bf03204114
  66. Lammers J, Crusius J, Gast A. Correcting misperceptions of exponential coronavirus growth increases support for social distancing. Proc Natl Acad Sci U S A. 2020;117(28):16264-16266. doi:10.1073/pnas.2006048117
  67. OECD. Trust in government. In: Government at a Glance. Paris: OECD Publishing; 2019.
  68. Krause LK, Gagné J, Höltmann G. Vertrauen, Demokratie, Zusammenhalt: wie unterschiedlich Menschen in Deutschland die Corona-Pandemie erleben. More in Common; 2020. [German]. https://www.moreincommon.de/media/a1hjp1zz/more-in-common_studie-corona-zusammenhalt.pdf.  Updated September 2020. Accessed November 2, 2020.
  69. Hermann M. COVID-19-Präventionsmassnahmen: Informationsstand, Einstellungen und Verhalten. Im Auftrag des Bundesamts für Gesundheit BAG. [German]. Bevölkerungsbefragungen. sotomo; DemoSCOPE. https://www.bag.admin.ch/dam/bag/de/dokumente/mt/k-und-i/aktuelle-ausbrueche-pandemien/2019-nCoV/bevoelkerungsbefragung-juli-2020.pdf.download.pdf/bevoelkerungsbefragung-juli-2020.pdf.  Updated August 28, 2020. Accessed February 19, 2021.
  70. Bartscher AK, Seitz S, Siegloch S, Slotwinski M, Wehrhöfer N. Social Capital and the Spread of COVID-19: Insights from European Countries. IZA Institute of Labour Economics; 2020.
  71. Borgonovi F, Andrieu E. Bowling together by bowling alone: social capital and COVID-19. COVID Economics. 2020(17):73-96.
  72. Hofstede Insights. Compare Countries. Hofstede Insights; 2020. https://www.hofstede-insights.com/product/compare-countries/.  Updated June 8, 2020. Accessed January 19, 2021.
  73. Karlhofer F. Sozialpartnerschaftliche Interessenvermittlung in föderativen Systemen: Ein Vergleich Deutschland - Österreich – Schweiz. [German]. In: Benz A, Lehmbruch G, eds. Föderalismus: Analysen in entwicklungsgeschichtlicher und vergleichender Perspektive. Politische Vierteljahresschrift. Sonderheft 32. Wiesbaden: Westdeutscher Verl.; 2002:234-252.
  74. Schweizer Radio und Fernsehen (SRF). 5. Corona-Umfrage der SRG - Mehrheit stützt die neusten Corona-Massnahmen des Bundesrats. [German]. https://www.srf.ch/news/schweiz/5-corona-umfrage-der-srg-mehrheit-stuetzt-die-neusten-corona-massnahmen-des-bundesrats. Updated October 30, 2020. Accessed November 6, 2020.
  75. infratest dimap. ARD-DeutschlandTREND extra “Coronamaßnahmen.” [German]. https://www.infratest-dimap.de/umfragen-analysen/bundesweit/ard-deutschlandtrend/2020/november-extra-coronamassnahmen/.  Updated November 5, 2020. Accessed February 19, 2021.
  76. Mazzonna F. Cultural differences in COVID-19 spread and policy compliance: evidence from Switzerland. COVID Economics. 2020(33):163-185.
International Journal of Health Policy and Management
Volume 11, Issue 8
August 2022
Pages 1342-1353

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History

  • Receive Date: 14 November 2020
  • Revise Date: 03 March 2021
  • Accept Date: 16 March 2021
  • First Publish Date: 21 April 2021

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