A Cross-National Survey on Health Perceptions and Adopted Lifestyle-Related Behavior during the COVID-19 Pandemic.

Background Though essential for controlling the viral spread, social isolation measures used during the corona virus-2019 pandemic, if implemented for long duration, could adversely modify health perceptions and lifestyle behaviors. Objective Given the lack of adequate real-time data on the public response on the lifestyle-behavior changes during the crisis of COVID-19 pandemic, the present cross-national survey was conducted. Methods A cross-national web-based survey was administered using Google forms during the month of April-2020. The settings were China, Japan, Italy, and India. There were two primary outcomes; 1) response on the health scale, defined as a perceived health status, a combined score of health-related survey items 2) adoption of healthy lifestyle choices, defined as the engagement of the respondent in any two of the three healthy lifestyle choices (healthy eating habits, engagement in physical activity/exercise, and reduced substance use). Statistical associations were assessed with linear and logistic regression analyses. Results We received 3371 responses; 1342 from India (39.8%), 983 from China (29.2%), 669 from Italy (19.8%), and 377 (11.2%) from Japan. The demographic profiles of the respondents are presented in Table 1. There was a differential country-wise response observed towards the perceived health status; highest scores for Indians 9.43(SD, 2.43), and lowest for Japanese 6.81(SD, 3.44) respondents. Similarly, country-wise differences in the magnitude of the influence of perceptions on health status were also observed; perception of interpersonal relationships was most pronounced in the comparatively older Italians and Japanese respondents (B coefficients=0.68 and 0.60, respectively] and of fear in Chinese respondents [B coefficient=0.71]. Overall, 78.4% of the respondents adopted at least 2 healthy choices of lifestyle, amidst the pandemic of COVID-19. Unlike health status, influence of perception of interpersonal relationships on adoption of lifestyle choices was not unanimous, was absent in the Italian respondents (Odds ratio=1.93, 95% CI=0.65-5.79). Influence of perceived health status was significantly predictor of lifestyle change across all the countries, most prominently by ~6-fold in China and Italy. Conclusions The overall consistent positive influence of increased inter-personal relationships on health perceptions and the adopted lifestyle behavior during the pandemic is the key real-time finding of the survey. The favorable behavioral changes should be bolstered through regularized virtual interpersonal interactions, particularly in countries with an overall middle-aged or elderly demography. Further, controlling the fear response of the public through counseling could also aid in better health perceptions and lifestyle behavior. However, the observed human behavior needs to be viewed within the purview of cultural disparities, self-perceptions, demographic variances and the influence of country-wise phase variations of the pandemic. Further, the observations are derived from a short lockdown period are preliminary, and a realistic insight could only be obtained from a longer follow up. Clinicaltrial Not required.