COVID-19 has killed hundreds of thousands of Americans and millions around the world in less than a year. The Coleman Group is conducting research that yielded positive results in changing behavior, attitude, and risk perception to improve health behaviors among a resistant population. This research adds data and understanding to the current national crisis, including vaccine misinformation, among a subpopulation rarely studied. We used a KAP survey (Knowledge, Attitude, Perception) and a behavior change intervention implemented in September 2020 that improved prevention behavior, attitude, and perception of risk.

Respondents with first-hand experience with COVID-19 diagnosis showed no appreciable differences in their KAP and behavior as those who didn’t.

People believe misinformation

Over 10% of respondents in our study population believe COVID-19 is a “hoax.” Information matters, and multilateral public health institutional leaders such as WHO and the UN have identified “an infodemic” with COVID-19, calling for research to assist populations who are at “high risk” for dis- and misinformation (WHO, 2020).

KAP: KNOWLEDGE

People follow rules and expect others to do so

KAP: ATTITUDE

The percentage of people who believe all measures should be voluntary is consistent in a state where most public health measures are voluntary or policies are non-existent. Voluntary measures are largely ineffective for large-scale and complex public health problems, especially in a crisis. Even when enforcement is challenging, Americans generally follow rules and expect others to do so. Public health efforts show that people originally preferring voluntary rules eventually align their preferences with enacted policies.


This finding is similar to nationally representative survey data. For example, sixty-one percent of conservative voters, on average, support government policies. (University of Cincinnati survey, Aug. 7 to Sept. 7). Governors with partisan constituencies may have additional latitude to contain COVID-19 and not alienate voters.

KAP: PRACTICE

Geosocial Study Area

Americans are not monolithic. Regional and community resistance to public health mitigation affects the health of the nation and the economy. The study target group is consistent with the demographic of Americans who follow public health guidelines at lower rates than fellow Americans, regardless of income, education, age, sex, and urban/rural residence, as shown consistently in nationally representative public interest surveys over many months. A specific area was studied to determine if an intervention could improve preventive behavior and positive KAP.