Pandemic-risk-related behaviour change in England from June 2020 to March 2022: REACT-1 study among over 2 million people

Objective To determine how people in England changed their infection risk-related behaviours during the COVID-19 pandemic and in response to control measures, 19 June 2020 to 31 March 2022. Design Over 18 (of 19) rounds, randomly selected participants across England completed a questionnaire about risk-related behaviours, socio-demographics, and symptoms. Participants Between 85,018 and 154,060 randomly selected participants per round, aged 5+ years, totalling 2,177,657 responses with relevant data. Main outcome measures Primary outcomes were self-reported shielding and/or taking specific precautions, not leaving home in the prior week, not being in close proximity with anyone outside their household the day before, and wearing face coverings outside the home. Secondary community-level measures of mobility and public health policy stringency were compared to the primary outcomes to provide population-level context to the observed findings.

Infection risk-related behaviours varied considerably over the nearly two years under study. Protective behaviours peaked in January 2021, during England’s winter wave, before widespread vaccination. At that time, the estimated proportion of self-reported shielding and/or taking specific precautions reached 21.6% (95% confidence interval 21.4% to 21.8%), of self-reported not leaving home in the week prior to completing the questionnaire reached 7.99% (7.85% to 8.13%) and of self-reported not having contact with anyone outside their household on the day before answering the questionnaire reached 89.2% (89.1% to 89.4%). As self-reported vaccination rates increased and prevalence of infection decreased, protective behaviours decreased, although patterns varied by demographics. Protective behaviours were strongly correlated with community-level mobility data and the stringency of public health measures.

Individual-based data showed sizeable proportions of people undertook protective behaviours during the pandemic especially during the second lockdown in January 2021 although there was evidence of “pandemic fatigue” in the study’s later stages. Self-reported behaviours were closely aligned with community mobility data and the stringency of government policies, indicating policy-driven behaviour changes. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study was funded by the Department of Health and Social Care in England. N.S. acknowledges support from the Oxford-Radcliffe Scholarship from University College, Oxford, the EPSRC CDT in Modern Statistics and Statistical Machine Learning (Imperial College London and University of Oxford), and A. Maslov for studentship support. M.C-H. acknowledges support from Cancer Research UK, Population Research Committee Project grant Mechanomics (grant 22184), the H2020-EXPANSE (Horizon 2020 grant 874627) and H2020-LongITools (Horizon 2020 grant 874739). M.W. acknowledges support from the Department of Health and Social Care, England, Expanse project (Horizon 2020 grant 874627). D.A. acknowledges support from the NIHR Imperial Biomedical Research Centre. GC is an NIHR Senior Investigator and is supported by the NIHR BRC of Imperial College NHS Trust. P.E. is director of the MRC Centre for Environment and Health (MR/L01341X/1 and MR/S019669/1). P.E. acknowledges support from the Department of Health & Social Care in England (NIHR and UKRI, REACT-LC, COV-LT-0040), the Medical Research Council (MR/V030841/1), the MRC Centre for Environment and Health (MR/S019669/1), and the UK Health Security Agency for the REACT-3 study (2024-2025). C.A.D. acknowledges support from the MRC Centre for Global Infectious Disease Analysis, the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, and the NIHR funded Vaccine Efficacy Evaluation for Priority Emerging Diseases (PR-OD-1017-20007). The Oxford Martin Programme in Digital Pandemic Preparedness is acknowledged for research funding (C.A.D.). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: We obtained research ethics approval from the South Central-Berkshire B Research Ethics Committee (IRAS ID: 283787). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Data are available online in the form of a portal. A link to this portal is provided in the preprint.