Understanding the impact of COVID-19 risk perceptions on mitigation behaviors: A mixed methods approach using survey instruments and serious games

COVID-19 risk mitigation behavior, including social distancing and mask wearing, was a principal factor influencing the spread of COVID-19. Yet this behavior, and its association with COVID-19 perceptions and beliefs, is poorly understood. Here we used a mixed methods approach combining serious game data with survey instruments to describe relationships between perceptions and behavior. Using a series of survey questions, participants were described along a spectrum denoting their perception of their susceptibility to COVID-19 associated with a list of activities. Afterwards, participants engaged with a serious game to examine behavioral responses to scenarios involving shopping at a grocery store and going to a park during simulated pandemic conditions. Messages describing the simulated infection risk were shown to drive many behavioral decisions. Another significant correlate, derived from survey results, was the participants perception of susceptibility associated with various activities for acquiring the COVID-19 infection. Individuals that perceived every day activities, such as grocery shopping, as unlikely to lead to a COVID-19 infection spent more time near others in the game-simulated grocery store environment compared to those that consider such activities as risky. Additionally, we found that participant behavior became increasingly risky as time progresses if they were lucky enough not to experience an infection. This reflects behavior observed in the United States and more broadly, possibly explains how people update their perception of the risk of activities. Overall, results show a link between perception and action with regards to COVID-19 and support the use of targeted risk messaging to influence behavior. Moreover, the link between reported real-world perceptions and game behavior suggest that serious games can be used as valuable tools to test policies, risk messaging and communication, with the goal of nudging individuals with varied and nuanced perceptions and belief sets towards behaviors that will reduce the impact of COVID-19.