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Health promotion and public health
Clear, consistent and credible messages are needed for promoting compliance with COVID-19 public health measures
  1. Lillian Hung1,
  2. Margaret Lin2
  1. 1 Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 Master of Health Leadership and Policy, The University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Lillian Hung, Nursing, The University of British Columbia, Vancouver, Canada; Lillian.Hung{at}

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Commentary on: Nivette, A., Ribeaud, D., Murray, A., Steinhoff, A., Bechtiger, L., Hepp, U., Shanahan, L., & Eisner, M. (2020). Non-compliance with COVID-19-related public health measures among young adults in Switzerland: Insights from a longitudinal cohort study. Social science & medicine

Implications for practice and research

  • Clear, consistent and credible messages are essential for promoting compliance with COVID-19 public health measures in young adults.

  • Research should further investigate the role of communication science in motivating collective emotions and behaviours for future public health measures.


As COVID-19 spreads worldwide, implementation and compliance with public health measures during the pandemic have been the foremost concern globally. The WHO highlighted that young adults had been the primary drivers of the spread of the novel coronavirus in many countries.1 This study by Nivette et al describes patterns of non-compliance with COVID-19 19-related public health measures in young adults and identifies which characteristics increase the risk of non-compliance.2


This prospective longitudinal cohort study included data from an ongoing cohort of children who entered the first grade of a Swiss primary school in 2004 (n=737). Non-compliance with COVID-19 public health measures and concurrent correlates were measured at age 22. In the survey, participants were asked whether they adopted protective behaviours (eg, handwashing and not touching the face) and social distancing. Data included sociodemographic variables and social psychological factors. Concurrent variables included perception of risk of infection, attitude towards moral norms and trust in government. Data were examined using generalised linear model regressions and bivariate analysis.


Young adults reported that their compliance rates with public health measures were generally high. Compliance was better for social distancing than hygiene-related practice. Respondents with lower-level education backgrounds were more likely to report additional social distancing non-compliance behaviours than respondents with higher-level education. Non-compliance was associated with individual characteristics (eg, low acceptance of moral rules, legal cynicism and lack of self-control). Non-compliance was associated with negative attitudes towards government authorities.


This study was timely and offered useful insights into public health strategies and policies that aim to motivate compliance with COVID-19-related measures. One strength of the study is the use of a prospective longitudinal cohort design. The longitudinal data allowed analyses of how antecedent and concurrent risk factors may be related to non-compliance with public health measures during the COVID-19 pandemic. The results identified non-compliance was associated with characteristics such as weak moral obligation and low trust in government authorities. Thus, more attention should be paid to human moral psychology and trust in designing communication strategies to influence public health measures’ compliance rates.

Public health messages must be clear and consistent, coming from a trusted, credible source. During the pandemic, the communication of information regarding the virus by Swiss authorities was consistent. However, messaging in other countries has been less consistent. For example, participants in a US study reported misinformation and conflicting messages caused the government’s loss of trust.3 Clear, consistent and credible messages are essential for promoting compliance with ongoing COVID-19 public health measures.

Targeted messages to engage young adults in supporting the COVID-19 pandemic response can be promoted through social media. Creatively, celebrities could help public health to deliver positive messages on social media. Rationales based on collective benefits should be clearly explained to connect people’s heads and hearts. Misinformation and common myths should be clarified. Framing communication messages with targeted information about risk and disease outcomes could persuade young adults to engage in effective behaviours to prevent infection spread.

Social and behavioural scientists point out governments should consider messages that emphasise benefits to the recipient, focus on protecting others, align with moral values, and appeal to social consensus or scientific norms.4 Format of health guideline advertising can be more bite-sized and topic-focused so that it can be easily redistributed to the targeted audience’s preferred social media and platforms.

The study demonstrates that clear, consistent and credible messages on social media are necessary to engage young adults in practising public health measures to prevent infection spread. By doing so, populations will be better protected against the spread of COVID-19 and better prepared for future epidemics and pandemics.

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.