Health Communications Trial with a Resistant Population to Increase Public Health Compliance during a Pandemic

Background: Georgia has among the worst rates of COVID-19 hospitalization and death rates in the nation. Many identifying as politically conservative resist public health mitigation measures, similar to populations in other politically conservative geographical areas. There are limited peer-reviewed public health communications designed for this population. We aimed to determine if an intervention using a fear appeal approach with efficacy during a pandemic can positively affect knowledge, attitude, perception, and/or behavior (KAP) in Georgia with this population. Methods: We delivered online video stimuli tailored to the geocultural characteristics of the target population. designed to stimulate fear, encourage efficacy, and counter mis- and disinformation. It used three routes to affect participants: narrative, direct messaging, and non-message cues. We measured risk aversion and conspiratorial ideation as moderating psychological factors using psychological batteries. Census and voting data were used to identify a convenience sample of 829 Georgia adults in an outer Atlanta suburb. Results: Exposure to the video, moderated by risk aversion, resulted in increased recommended mitigating behavior to prevent COVID-19 (13.7%, 95% CI: 2.7% to 24.7%,) and increased positive attitude toward the recommendations (7.7%, 95% CI: 5.9% to 9.3%). Exposure to the video, moderated by conspiratorial ideation, resulted in an increase in perception of COVID-19 risk (7.6% 95% CI: 1.8% to 13.5%) among participants. Conclusions: An intervention using a fear appeal approach with efficacy during a pandemic can positively affect attitude and risk perception of a politically conservative population. Scaling similar interventions with resistant geocultural populations has promise of increasing adherence to public health recommendations. The moderating factor of conspiratorial ideation is relevant given conspiracies during pandemics, such as COVID-19. This multidisciplinary study contributes to the extant literature by providing insights of populations influenced by contrary political attitudes.