Development of transmission-reducing behaviour adherence measure (TRAM) for monitoring and predicting transmission-reducing behaviours during the pandemic

Chantal den Daas* (Corresponding Author), Marie Johnston, Gill Hubbard, Diane Dixon

*Corresponding author for this work

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There is a need for a measure to monitor adherence to transmission-reducing behaviours (TRBs) during pandemics. An adherence measure can monitor current TRBs, assess change over time and, potentially, predict later behaviours. The TRB adherence measure (scale consisting of seven items) includes questions based on government behavioural directives in Scotland that were common internationally, i.e., physical distancing, face covering and hand hygiene. Data were collected weekly for 6 weeks at the beginning of the pandemic, including a later follow-up repeated measure of some participants, in 20-minute structured telephone surveys with a nationally representative random sample of adults in Scotland. A total of 2969 people completed the adherence items and were highly adherent. Confirmatory factor analysis supported a unidimensional scale (CFI = .95; TLI = .93; RMSEA = .08; SRMR = .08), although internal consistency was low (Cronbach’s alpha = .49). The adherence score significantly predicted adherence to a validity test item (ΔR2 = .114, F(1,2964) = 379.76, p < .001). It also predicted adherence to TRBs later over and above personal habitual styles (Creature of Habit Scale: COHS). The adherence score has been developed for routine monitoring of adherence to TRBs during the COVID-19 pandemic. It can be used to predict future similar behaviours and adherence to other behaviours, although it may be necessary to explore adherence to the specific behaviours occasionally. Adherent behaviour for one TRB is likely to be associated with adherence to government directives to other TRBs. Importantly, these TRBs are likely to be crucial in reducing COVID-19 case numbers, as well as protecting against other infectious diseases including influenza and the common cold.

Original languageEnglish
Pages (from-to)1671-1681
Number of pages11
JournalPsychology, Health and Medicine
Issue number7
Early online date19 Oct 2022
Publication statusPublished - 1 Aug 2023

Bibliographical note

Funding Information:
We would like to thank the participants, the Scotland-wide consortium of 33 behavioural and health scientists, and our PPI Groups. CHARIS was funded via a grant from the Chief Scientist Office, Edinburgh (COV/ABN/20/07).


  • adherence
  • behaviour
  • COVID-19
  • measure
  • transmission-reducing behaviours


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