High Public Health Guideline Compliance But a Collapse in Perceived Government Effectiveness During the COVID-19 Pandemic in Canada: Findings from a Longitudinal Cohort Study

Background: The coronavirus disease 2019 (COVID-19) pandemic has imposed enormous adversity worldwide. Public health guidelines have been a first line of defense but rely on compliance with evolving recommendations and restrictions. This study sought to characterize adherence to and perceptions of public health guidelines over a one-year timeframe during the pandemic. Methods: Participants were 1435 community adults in Ontario who completed up to five assessments (April 2020; July 2020; October 2020; January 2021; and April 2021; 92% retention). Participants were assessed for adherence to government protocols and perceptions of government response (importance, compliance, and effectiveness). Analyses used general linear mixed-effects regression modelling of overall changes by time and differences based on age, and sex. Findings: Over time, participants reported high or increasing engagement in public health guidelines, including physical distancing, restricting activity, and masking. In contrast, participants exhibited notable reductions in importance and compliance, with evidence of more negative changes in younger participants. Most dramatically, participants reported a substantial reduction in perceived government effectiveness, from predominantly positive perceptions to predominantly negative perceptions. Interpretation: These results illuminate evolving trends in public health compliance and perceptions over the course of the pandemic in Canada, revealing the malleability of public perceptions of public health recommendations and government effectiveness. Funding: This research was funded by a grant from the Canadian Institutes of Health Research (CIHR). Declaration of Interest: None to declare. Ethical Approval: The study’s procedures were reviewed and approved by the Hamilton Research Ethics Board (Protocol #4699).