Adherence to Public Health Recommendations, Restrictions, and Requirements among Priority Populations at Risk for COVID-19 Mortality and Infection in Australia

ObjectiveTo examine adherence to COVID-19 public health measures among culturally and linguistically diverse (CALD) and low socio-economic status (SES) populations in Victoria using a unique longitudinal cohort. Study DesignThe Optimise Study was a mixed-methods longitudinal cohort and social networks study (September 2020 - December 2023) assessing the impact of COVID-19 and related public health measures in Victoria, Australia. We used a serial cross-sectional design to analyse adherence to public health recommendations, restrictions, and requirements. Settings, participantsThe study examines two 28-day periods during the COVID-19 pandemic in Victoria: April 23- May 20, 2021 ( non-lockdown), and September 13-October 10, 2021 ( lockdown). We explored adherence to three categories of COVID-19 public health measures -- Recommendations (non-enforced, longer-term), Restrictions (mandated during lockdown periods), and Requirements (mandated, longer-term) -- among participants who completed questionnaires during these periods. Participants were grouped as: 1) non-CALD high SES (did not meet CALD or low-SES criteria), 2) CALD, or 3) non-CALD low-SES. Main outcome measuresPrimary outcomes were adherence to Recommendations, Restrictions, and Requirements during the two study periods. ResultsOf 782 participants recruited, 579 (75%) completed a survey or diary during at least one study period and were included in the analysis. Of these, 275 (47%) were in the non-CALD high-SES group, 114 (20%) in the CALD group, and 190 (33%) in the non-CALD low-SES group. Across all groups, risk-reduction behaviours increased during the lockdown. CALD participants showed higher adherence to some Recommendations and Restrictions compared to the other groups. Overall, 28% left home while awaiting a COVID-19 test result, commonly due to work. ConclusionsHigh adherence among CALD and non-CALD low-SES groups suggest structural barriers, rather than behavioural non-compliance, contributed to higher COVID-19 impacts, highlighting the need for tailored support. During future public health emergencies, better supports are needed for individuals working outside of home to remain in isolation while awaiting a test result. Summary box O_TEXTBOXWhat is already known about this subject? In Australia, priority populations such as culturally and linguistically diverse (CALD) and low socio-economic status (SES) groups experienced higher COVID-19 infection, mortality and a disproportionate impact from public health restrictions. What does this study add? CALD populations had an overall higher level of adherence to public health behavioural measures during both lockdown and non-lockdown periods compared to non-CALD populations. Over 25% of participants did not comply with stay-at-home requirements while awaiting a COVID-19 test result, largely due to work responsibilities. How might this impact on clinical practice? Pandemic preparedness efforts should focus on understanding the reasons for non-adherence with isolation requirements and considering tailored support during future pandemics to address the diverse C_TEXTBOX