COVID-19 Family Dynamics and Health Protective Behavior Adherence: A 16-Wave Longitudinal Study

Objective: Health-protective behavior (HPB) adherence (wearing protective face masks, social distancing, and increased handwashing) plays a critical role in reducing infectious disease transmission; yet factors underlying HPB adherence are not well understood. Most research focuses on individual factors-beliefs about susceptibility, severity, and HPB efficacy; however, understanding parent and child HPB adherence may require a family conceptualization. This study evaluated whether family relations (cohesion, conflict, and chaos), as well as parent-child conflict regarding pandemic-specific circumstances (e.g., social distancing prohibitions about spending time with friends) account for parent and child HPB adherence, over and above parents' individual concerns about COVID-19 risks. Method: This study utilized data reported by parents in 204 families with children (Mage = 4.2; 45% girls) collected on 16 occasions between May 2020 through April 2021. The impact of within-person (WP) and between-person (BP) effects of each family-level factor on parent and child HPB adherence was evaluated in a series of two-level multilevel models. Results: Over the course of the study, parent HPB adherence was generally stable and child HPB adherence declined early on but then leveled off. Results showed the protective effect of family cohesion for both parent and child HPB adherence at the WP and BP level. In addition, periods of higher COVID-19-related conflict corresponded to increases in parent and child HPB adherence. Conclusions: Intervention efforts should be directed at promoting family cohesion in order to promote sustained parent and child HPB adherence. Public Significance StatementFamily factors are commonly overlooked in efforts to support health protective behavior (HPB) adherence (e.g., social distancing, masking). Past work emphasizes individual beliefs about susceptibility and severity of the virus as important predictors of HPB adherence. However, family factors-especially family cohesion-also predict parent and child HPB adherence, over and above susceptibility and severity beliefs. Family-focused interventions may bolster efforts to promote HPB adherence and maximize public health protection.