Behavioural precautions to avoid transmission of the COVID-19 virus – low educated groups are not always lagging behind

Introduction
According to the ‘diffusion of innovations’ model, innovations do not spread randomly in a population, but follow specific patterns. Changes in health behaviours tend to start among high status groups. The purpose of the present study is to describe dimensions of coronavirus-related behaviour and their relationship with level of education at a relatively early stage of the COVID-19 pandemic.

Material and methods
Data collections (internet-based) took place among adults (18+) in two Norwegian counties, Oslo and Vestland, in November and December 2020 (N = 15,071). The response rates were 39.8% (Oslo) and 37.3% (Vestland). Data were analysed with principal components analysis, construction of unweighted meanscores, and generalized linear models.

Results
Five behavioural dimensions (two single items out of 23 not included) were identified: Hygiene, Hygiene when hands are dirty, Avoiding meeting others, Keeping distance from others, and Wearing a protective face mask. Analyses with meanscores as outcome variables revealed that only one of the five dimensions, in addition to the single item Stay at home if ill (men only), was positively related to level of education, namely Wearing a protective face mask. There was no significant difference between educational groups with regard to Hygiene when hands are dirty and Keeping distance from others. On Hygiene, Avoiding meeting others (men only), and Avoided public transport (single item) scores were inversely related to level of education.

Conclusions
Behavioural precautions to avoid transmission of COVID-19 do not follow the general tendency for positive health behaviours to be most rapidly adopted by well-educated groups. On four of five behavioural components, this association is either close to zero or reversed. In addition to high levels of trust in authorities in Norway, there are characteristics of the COVID-19 health education campaign which might explain why: Continuous and intense mass media coverage, use of multiple communication channels, strength of appeals, and high communicator credibility.