Incipient Illness Representations and Protective Behaviours During Covid-19: Results From a Longitudinal Study of Representative Samples of the Population of Scotland

Background: COVID-19 provided rare opportunity to track development of population understanding of a disease. Common Sense Self-Regulation Model (CSSRM) proposes that new health threats are integrated with previous experiences of illness to develop new mental representations which guide coping efforts. We examined development of illness representations and relationship to protective behaviours before vaccinations.
Methods: Serial observational study assessing 10 illness representations in 13 randomly selected samples of Scottish population (N = 6420). Participants recruited and interviewed by telephone.
Results: Anxiety, consequences, and personal control representations most strongly endorsed; worry and treatment control least. Consequences and timeline (recurrence) significantly increased over time [F(12, 3952) = 2.00, p = 0.05, p2 = 0.01, and F(12, 3952) = 6.65, p 0.001, p2 = 0.02]. Older/more deprived endorsed illness representations more strongly than younger/less deprived. Men endorsed identity and personal control more, and timeline and emotional representations less than women. Adherence to protective behaviours associated with greater identity, consequences and timeline (Standardised Beta B = 0.035, standard error SE = 0.029; B = 0.129, SE = 0.033; B = 0.069, SE = 0.033; B = 0.083, SE = 0.033 respectively).
Conclusions: Pre-vaccination, control of COVID-19 perceived as personal rather than due to treatment; protective behaviour adherence was associated with strong illness representations. Beliefs about consequences and recurrence increased over time, perhaps reflecting increasing knowledge. Older and deprived endorsed all representations more strongly, perhaps reflecting greater perceived vulnerability. Further data on perceived causes and representations following availability of vaccination will add to this picture.