Measuring Italian citizens' engagement in the first wave of the COVID-19 pandemic containment measures: A cross-sectional study.

Background: In January 2020, the coronavirus disease 2019 (COVID-19) started to spread in Italy. The Italian government adopted urgent measures to slow its spread. Enforcing compliance with such measures is crucial in order to enhance their effectiveness. Engaging citizens in the COVID-19 preventive process is urgent today both in Italy and around the world. However, to the best of our knowledge, no previous studies have investigated the role of health engagement in predicting citizens' compliance with health emergency containment measures.

Method: An online survey was administered between February 28 and March 4, 2020 on a representative sample of 1000 Italians. The questionnaire included a measure of health engagement (Patient Health Engagement Scale), a 5-item Likert scale ranging from 1 to 7, resulting in 4 positions that describe the psychological readiness to be active in one's own health management, and a series of ad hoc items intended to measure citizens' perceived susceptibility and severity of the disease, orientation towards health management, trust in institutional bodies, health habits and food consumption. To investigate the relationship between health engagement and these variables, ANOVA analysis, logistic regression and contingency tables with Pearson's chi-squared analysis have been carried out.

Results: Less engaged people show higher levels of perceived susceptibility to the virus and severity of the disease; they are less trustful of scientific and healthcare authorities, they feel less self-effective in managing their own health-both in normal conditions and under stress-and are less prone to cooperate with healthcare professionals. Low levels of health engagement also are associated with a change in the usual purchase behavior.

Conclusions: The Patient Health Engagement model (PHE) provides a useful framework for understanding how people will respond to health threats such as pandemics. Therefore, intervention studies should focus on raising their levels of engagement to increase the effectiveness of educational initiatives intended to promote preventive behaviors.