ArticleBMJ public health2026
Adherence to public health recommendations, restrictions and requirements among priority populations at risk for COVID-19 mortality and infection in Victoria, Australia: a serial cross-sectional study.
Article in BMJ public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: To examine adherence to COVID-19 public health measures among culturally and linguistically diverse (CALD) and low socioeconomic status (SES) populations in the Australian state of Victoria using a unique longitudinal cohort. Methods: The 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. The study examines two 28-day periods during the COVID-19 pandemic in Victoria: 23 April-20 May 2021 ('non-lockdown') and 13 September-10 October 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. Primary outcomes were adherence to recommendations, restrictions and requirements during the two study periods. Results: Of 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 with the other groups. Overall, 28% left home while awaiting a COVID-19 test result, commonly due to work. Conclusions: High 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.
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