Behavioral insights during the COVID-19 pandemic in the Federation of Bosnia and Herzegovina: the role of trust, health literacy, risk and fairness perceptions in compliance with public health and social measures

Background and aim: Public health and social measures (PHSM) are critical aspects of limiting the spread of infections in pandemics. Compliance with PHSM depends on a wide range of factors, including behavioral determinants such as emotional response, trust in institutions or risk perceptions. This study examines self-reported compliance with PHSM during the COVID-19 pandemic in the Federation of Bosnia and Herzegovina (FBIH). Materials and methods: We analyze the association between compliance and behavioral determinants, using data from five cross-sectional surveys that were conducted between June 2020 and August 2021 in FBIH. Quota-based sampling ensured that the 1000 people per wave were population representative regarding age, sex, and education level based on the data from the latest census in Bosnia and Herzegovina. One-way analysis of variance (ANOVA) was used to identify significant changes between studies on determinants and PHSM measures. Regression was used to find relations between behavioral determinants and PHSM. Results: Participants reported strong emotional responses to the rapid spread of the virus and its proximity to them. Risk perception was spiking in December 2020 when rates of infection and death were particularly high. Trends in policy acceptance were divergent; participants did not rate PHSM as exaggerated, but perceived fairness was low. Trust in institutions was low across all waves and declined for specific institutions such as the health ministry. In five wave-specific regression analyses, emotional response (βmin/max = .11*/.21*), risk perception (βmin/max = .06/.18*), policy acceptance (βmin/max = .09/.20*), and trust in institutions (βmin/max = .06/.21*) emerged as significant predictors of PHSM. Conclusions: This study contributes to the body of research on factors influencing compliance with PHSM. It emphasizes the importance of behavioral monitoring through repeated surveys to understand and improve compliance. The study also affirms the impact of public trust on compliance, the risk of eroding compliance over time, and the need for health literacy support to help reinforce protective behaviors.